M&M - Dr. Keller

Elderly Demented Pt s/p "Fall"

• First, define and characterize the "fall" as best you are able. 
  
• Be careful focusing only on mechanical issues.  Was this Syncope?
  

• Learning point - abdominal aortic aneurysm
  

        - rare before age 50,
        - family hx is the greatest risk factor - increases risk 10 fold
        - smoking is the most important modifiable risk factor

            - Triad of pain, hypotension, pulsatile mass = 10%
            - 60% of patients with ruptured AAA - normal vitals signs
            - bedside US - sensitivity/ specificity 98%

Sore Throat After Intubation

• Post intubation sore throat - usually gone by 5th  day -- persistent pain warrants concern.
  
• Common traumas
  

            - dental injury or lip abrasion
            -  foreign body
            - vocal cord laceration
            - tracheal or esophageal perforation

Is that a Pneumothorax

    > Pneumothorax ex vacu - forms adjacent to atelectatic lobe, results from bronchial obstructions - do not treat with chest tube - relieve but fixing obstruction

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