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team challenge core concepts
1. Pediatric Chest Pain - MyocarditisDifficult diagnosis to make and often missed, occasionally with fatal consequences. Remain vigilant!ECG is most sensitive study, though still only 90% Sinus...
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Bifascicular Block and Second Degree AV Block 1. In asymptomatic individuals, chronic bifascicular block does not usually require cardiac work-up; the prognosis is generally benign 2. The...
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Carolinas Case Conference - Dr. Beverly
Bariatric Patients Operations for weight loss include a combination of volume restrictive and nutrient malabsorptive procedures that affect satiety, absorption, and insulin sensitivity hormonal or...
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Trauma Imaging - Dr. Gibbs
GCS = 15: 5-6% [+} CT, <1% surgeryBoth the New Orleans and Canadian Head CT Rules are highly SENSITIVE for important TBI... the later is more SPECIFIC.C-Spine Injuries: 1% children, 2% adults, 4%...
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Snake Bites - Dr. Kallgren
Epidemiology: vast majority of snake bites are from nonvenomous snakes, fatalities extremely rareCrotalids (vipers) have hemotoxic venom, Elapids (cobras) have neurotoxic venomSix venomous species in...
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Benign Headaches in the ED - Dr. Goldonowicz
- Only approximately 5% of all headaches that present in the ED are true emergencies- After evaluating for potential emergencies and performing a full neuro exam, pause and consider if any of the...
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Neuro Imaging - Dr. Asimos
The mnemonic for systematically evaluating a non-contrast head CT is “Blood Can Be Very, Very Bad”.A Reassuring CT:· No Blood is seen· All Cisterns are present and open· Brain...
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Carolinas Case Conference - Dr. Nichols
Wellens Syndrome-Remember, there are both Type A and Type B Wellens findings on EKG-Both are extremely high risk for unstable LAD occlusion and reperfusion-Treat like a ACS-Emergent cardiac...
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Carolinas Case Conference - Dr. Young
Myocarditis:- broad spectrum of disease, high level of suspicion is essential- myocarditis can mimic STEMI and Wellens syndrome among others- EKG, echo, and cardiac enzymes cannot rule in/out the...
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What Goes Up, Must Come Down: Priapism - Dr. Puciaty
· Erections lasting more than 4 hours are a medical emergency.· Secondary to impaired contraction of corporal smooth muscle.· Immediate aspiration/irrigation and/or injection of phenylephrine are the...
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Sharpen Your Calipers: Wide Complex Tachycardia - Dr. Littmann
General 1. WCT algorithms do not work in the real life setting 2. Don’t pay attention to what others have said; you need to evaluate the ECG yourself 3. First question: is the WCT regular...
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Carolinas Case Conference - Dr. West
Confusion about epinephrine - Anaphylaxis o Standard: 0.3-0.5 mg IM 1:1,000 (can repeat q5 minutes) o Pediatric: 0.01 mg/kg IM 1:1,000 o Severe/refractory: 0.1mg 1:10,000 IV over 5 minutes +...
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Ped Sedation - Dr. Scarboro
Be a patient advocate. When preparing for a procedure, attempt to minimize discomfort or pain, and set yourself up for success.When discussing options for a procedure, consider 5 key aspects: Motion...
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Chest Trauma Pearls - Dr. Colucciello
Indication for Pre-hospital needle decompression of chest for suspected tension pneumothorax is hypotension1/3rd of traumatic aortic disruptions may not have external signs of traumaECG most important...
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Carolinas Case COnference - Dr. NIchols
Tuberculosis-Immediately isolate any patient that you believe may have TB, and document that you have done so!-Upper lobe pneumonia should always prompt further consideration of tuberculosis, screen...
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Vertigo, Nystagmus, BPPV & Cerebellar Stroke - Dr. Asimos
1. The first key in assessing a patients with dizziness is to define the problem: dizziness is not a medical term, and vertigo is not a diagnosis.2. If a patient has nystagmus, it is...
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Aortic Dissection - Dr. Jackson
- We are not very good at making the diagnosis…correct as initial diagnosis only 15-50%- Type A involves ascending aorta and requires immediate cardiothoracic surgeon, Type B does not.- CT Angio is...
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Child Abuse & Toxins - Dr. Beuhler
· Consider poisoning when confronted with confusing clinical presentations· Always save and freeze initial urine from suspicious cases· “Munchausen’s by proxy” is now known as...
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Carolinas Case Conference - Dr. Beverly
Cryptococcal Meningitis:Opportunistic infection in HIV/AIDS patientsSymptoms can be vague but most commonly present with fever, neck stiffness, headache and altered mental statusDiagnosis is by lumbar...
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Ketamine: Not Just for Kids - Dr. Mollo
Consider Ketamine for:Awake patients who need short, painful proceduresRSI in critically ill trauma/burn patientsDSI (delayed sequence intubation) in patient with asthma/poor reserveHysterical...
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