Grand Rounds Recap 1/13

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Grand Rounds Recap 1/13

R1 CLINICAL KNOWLEDGE ON ESOPHAGEAL EMERGENCIES WITH DR. CONTINENZA

Boerhaave's syndrome: Full thickness esophageal perforation

  • Thought to be due to suddenly increased intra-esophageal pressure

  • 60% of perforations thought to be iatrogenic, most commonly related to upper endoscopy

  • Chest X ray most of the time will have some abnormality, although it may just appear as a pneumonia. Pneumopericardium and obvious signs of mediastinitis may be rare on initial chest X ray, especially early in the disease process or with smaller esophageal tears and less mediastinal inoculation

  • CT scan is diagnostic modality of choice. If unavailable, upper GI series with Gastrograffin (less sensitive than barium though also less inflammatory reaction) is a better option that barium (greater sensitivity, more associated inflammation/potential for mediastinitis). 

  • Treatment is broad spectrum antibiotics as a broad spectrum of oral and pharyngeal bacteria can be involved

  • Mortality is high and increases drastically with delays in diagnosis

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Grand Rounds Recap 12/30/15

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Grand Rounds Recap 12/30/15

Morbidity and Mortality Conference with Dr. LaFollette

Tracheoinnominate Fistula

One of the most dreaded days in the ED, a post-trach patient presents with a small bleed that stopped, is this one of 50% of patients with a TI fistula waiting to unleash?

  • 0.3% occurrence after routine tracheotomy
  • Incidence peaks 7-14 days after procedure

Once the patient starts massively bleeding - what's your next move hotshot?

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    Out on a Limb - "Is there a Doctor on Board?!"

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    Out on a Limb - "Is there a Doctor on Board?!"

    You are enjoying a cocktail on the way to Hawaii on a well earned vacation when a voice comes aloud overhead, “Attention all passengers. If there is a doctor or health care provider present, we ask that you please come to the front of the plane immediately.” From your vantage point in the back of the plane, it becomes clear very quickly that no one is volunteering. You find yourself being stared at by a plane full of people as you make your way to the front, to find a morbidly obese Caucasian female with a flight attendant at her side. You start your encounter…

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    Disaster and Emergency Medicine: An Overview

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    Disaster and Emergency Medicine: An Overview

    Disaster. It’s trending right now. In the last few years we have seen epidemic outbreaks of hemorrhagic fever, earthquake induced nuclear meltdowns, and large-scale civil war. It is no secret: both the scale and frequency of disasters are increasing. This appears to be due to a complex interplay of interconnected, global factors that show no signs of slowing. More people means harvesting more food, tapping more clean water, clearing more land, crowding more cities, and releasing more harmful products into the environment. The consequences to this include rising water levels, widening temperature extremes, increasing erosion, and a growing number of vulnerable people. With inevitably more disaster on the horizon, preparedness and experienced leadership are critical for the world’s future.

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