Grand Rounds Recap 5/4

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Grand Rounds Recap 5/4

Acetaminophen Toxicity Sim - Drs. LaFollette, Nelson and Toth

Take a read through our Cases If It Bleeds it Leads..., Seeing is Believing..., and Belly Pain Bonanza. Curated commentary to follow

Acetaminophen Toxicity

  • 60,000 poisonings / year
  • ~500 deaths per year, evenly split therapeutic / suicide
  • Mechanism - acetaminophen to NAPQI by P450, overwhelming gluthathione stores
  • Alcohol, phenytoin, isoniazid all induce P450 and may increase NAPQI production. Chronic alcohol use will worsen toxicity when acute ingestion will competitively inhibit and can be preventative at producing the toxic metabolite
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Belly Pain Bonanza

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Belly Pain Bonanza

It's been a busy Monday night shift.  2 hours in and it seems like all you've seen is belly pain after belly pain.  You hesitate and think maybe it's just a figment of your imagination but a quick look at the track board tells you nope, 5 patient's with abdominal pain in your 10 bed pod and a new patient arriving to C40 with, of course, abdominal pain.  You meet the squad and get report...

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Seeing is Believing...

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Seeing is Believing...

You settle in to your 6th of 6 shifts in a row in B Pod in your tertiary referral center when you sign up for your first patient. Ms. Circling is an 86 year old female who presents with abdominal pain and altered mental status. She presents with her family who gives most of the history that for the last 2 days the patient has been complaining of abdominal pain and has not been eating or as active as normal...

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If it Bleeds, it Leads………

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If it Bleeds, it Leads………

It’s late on a Saturday night and you are moonlighting as the single provider at a community hospital about 15 minutes from UC. You’re trying to disposition five current patients when a new patient is brought in by EMS with a complaint of vomiting blood. The patient smells of alcohol and states that he drinks daily, though he may have “overdone it” the last 2-3 days since he has had friends in town...

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