1) "The brownie on eights are tricky" - translated to febrile neonates are tricky - must remain vigilant! 2) knowledge is important, but we must recognize limitations (regarding studies, gray areas, etc.) 3) scheduled and ensured hospital follow-up is essential!
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1. SBIRT is an effective strategy to change behavior of patients with substance abuse problems 2. Standard screening tools exist to identify patients that would benefit from Motivational Interviewing. These include the AUDIT and DAST-10. 3. Brief Motivational Interviewing requires identifying where the patient is in the stages of change and engaging them with reflective listening to motivate further change. 1. ITP is a diagnosis of exclusion, laboratory findings other than isolated thrombocytopenia and the associated symptoms should suggest an alternative diagnosis. 2. TTP has an extremely high mortality and early initiation of plasma exchange therapy and hematology consult can drastically improve patient outcomes. 3. DIC can be caused by many medical conditions and treatment should be at the underlying cause 4. In general, platelet transfusion is not the appropriate treatment for ITP, TTP and DIC and is often contraindicated 1. Cervical check every pregnant patient who presents with potential labor. 2. Start with transabdominal US for pregnant patients before advancing to transvaginal US. Sometimes "dates" are incorrect! 3. Be sure to ask pregnant patients about history of reproductive assistance/REI drugs. 4. Use the airway checklist for intubation preparation.
• Urethral injury should be suspected and excluded in patients with pelvic fractures • Although efforts have been made to standardize capacity assessments, they are complex and subjective. Take opportunities to introduce the benefits of advance directives early. • All patients with unexplained hematuria need to be informed of this finding and have close follow up.
1) Not all vomiting in the Peds ED is gastroenteritis! Consider trauma, metabolic, foreign body, etc.. 2) Always do your own history and exam; never assume that previous providers thought of everything. 3) Must be cognizant of abuse across the spectrum of patients that present to the CED, and know risk factors and red flags 1. Leukemia is the most common form of childhood cancer (30% of all pediatric malignancies) 2. Presenting symptoms for acute leukemia are typically non-specific and the WBC is usually normal! Have a high degree of suspicion. 3. Red flags include: unexplained fever, multiple cytopenias, hepatosplenomegaly, petechiae/purples, easy bleeding, lymphadenopathy. 4. Risk factors for medical error in the ED: Night shift, handoff, high volume times with many interruptions, "difficult" patient 5. Recall specific cognitive error types: A. Premature closure B. Confirmation bias C. Order effect 1. Primary injury - overpressure from blast waves - air-containing organs most susceptible to injury - damage to lungs (pulmonary blast injury) most common injury to immediate survivors 2. Secondary injury - from projectiles 3. Tertiary injury - victim thrown against wall, etc 4. Other injuries - burns, smoke inhalation, delayed complication On-scene triage - same as any other mass casualty event (START) - danger to first responders from secondary blast, building collapse ED Response - most immediate survivors will not have life threatening injury, but triage is challenging - close monitoring and thorough evaluation for development of pulmonary blast injury - positive pressure ventilation and air transport increase risk for developing air embolism - nearly all patients with PBI will also have ruptured TMs - empiric antibiotics for all patients with soft tissue injury or if concerned for intraabdominal injury |
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