TEAM Challenge Cases - Drs. Fox, Griggs, MacNeill

Ovarian Torsion

 - Ovarian Torsion requires us to be vigilant.  It is often misdiagnosed initially by both EM and GYN physicians.
 - Reconsider your DDx.  "Appendicitis" and "Renal Colic" are common mimics of Ovarian Torsion.
 - Fight diagnostic momentum.
 - Don’t be fooled by “normal blood flow.” The ovary has two arterial supplies. Diminished venous flow should be alarming even if there is "normal" arterial flow. 
- See Ovarian Torsion.

Perforated Gastric Ulcer

 - Review your own films! Radiologists are human too. You know what your concern is and may be able to actively see the important abnormality more easily!
 - Concerning abdominal exam? You don't need to wait for images to call a surgeon.
- Think twice before sending to CT, especially with a concerning abdominal exam. 
- Resuscitate aggressively! Prepare for the patient to become dramatically more ill!
- Don’t forget the broad spectrum antibiotics!

Ruptured AAA

- Resuscitate! (ABCs, Large Bore Access), but be comfortable with permissive hypotension.
- Target SBP ~80-90 mmHg


- Do not be in a hurry to intubate the patient if they are breathing on their own.  Many arrest after intubation.  
- IF you must intubate, VENTILATE SLOWLY. Increased intra-thoracic pressure will crush their already tenuous pre-load and cause an arrest.

- Cross-matched PRBCs (consider massive transfusion protocol)
- Contact your Vascular Surgeon emergently
- At CMC, activate “Code Rupture”