M&M - Dr. Zahn

The Return ED Visit

• Learning points - everyone has biases - realize yours
• Errors in medicine do happen. Learn from these errors. Make a personal protocol/checklist to review all data before any major decision (admission vs discharge).

• Pneumonia - know what the risks are (we have a powerplan! - ED Adult pneumonia - community acquired)
• Provide excellent documentation in pneumonia patients. Clearly document risk factors (or lack of) for HCAP, MRSA, Pseudomonas. This will allow you to choose appropriate antibiotic coverage. 

"BB" Shot to Right Groin... 

• Xray showed "BB" above right inguinal ligament. 
• CT showed ballistic had moved further.
• Repeat films showed BB in the chest.

Bullet Embolism 
- Bullet embolism is extremely rare. 
- Requires multidisciplinary management. 
- Consider possibility if missile lays next to major vessels or bullets are found in unexpected locations. 
- Venous more common than arterial


FLU
1st presentation - viral symptoms. 2nd presentation - viral symptoms. 3rd presentation (within 24 hours) - SHOCK with Resp Failure

• Vital signs are vital.
• Consider second visits as opportunities to not make the same mistake twice. Doesn't mean admit them; means re-consider the bad things.

Tamiflu is not magic... 

• When prescribing Tamiflu, know the evidence and pros/cons. Cost, side effects, limited efficacy, and possibility of causing resistance strains should all be considered. Have this discussion with your patients.

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