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TEAM Challenge Cases - Drs. Fox, Griggs, MacNeill

7/2/2015

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Picture

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”


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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Fellowships at CMC
    • Ultrasound
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
  • PEOPLE
    • Program Leadership
    • Current Chiefs
    • PGY-3
    • PGY-2
    • PGY-1
    • Recent Grads >
      • Class of 2023
      • Class of 2022
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Incentive Shifts & Moonlighting >
      • AEC Incentive Shifts
      • STICU Moonlighting
      • MICU X moonlighting
      • Cardiac Rehab >
        • Pineville Cardiac Rehab
        • Union Cardiac Rehab
    • Schedules >
      • Block Schedule
      • ED Shift Schedule
      • Conference and Resident Lectures
      • Journal Club
      • CQR
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction
    • Off Service Rotators