![]() 1. Intussusception is the most common cause intestinal obstruction in infants between 6 and 36 months of age. 2. It usually presents with intermittent abdominal pain and sometimes vomiting, however lethargy or altered mental status can be the initial presenting sign. 3. In any infant or child presenting with altered mental status, think of intussusception as possible etiology. 4. In stable patient with no signs of perforation who has signs of intussusception, nonoperative reduction is recommended. 5. Surgical treatment is the primary intervention for patients who are unstable or have evidence of perforation.
0 Comments
Sneaky Ectopic - Dr. Nichols![]()
GIB and Aortic Graft - Dr. Beverly![]()
Pulmonary embolism + pleural effusion - Dr. West![]()
Traumatic Ptx, Be Kind - Dr. Robertson![]()
![]() Ottawa SAH Rule mneumonic: “ANT LEaF” (warning – this rule not yet validated) · Age >40 · Neck pain or stiffness · Thunderclap headache · Loss of consciousness (witnessed) · Exertion (onset during) · and · Flexion (limited of the neck on exam) Asimos approach is no “routine” LP needed if thunderclap onset H/A with normal head CT performed within 6 hours of H/A onset, with the following caveats: · Recognize this approach is not incorporated into any published guidelines · Assumes all of the following: 1. Classic thunderclap headache 2. No neurological findings 3. No meningismus 4. No prominent neck pain 5. No family history of SAH 6. CT performed within 6h of onset, and read by a neuroradiologist ![]() Eating Disorders: Chronic disorder with acute complications: 1.Clinically prevalent eating D/O 16%; 3rd most common adolescent females, increased ED utilization, Anorexia highest mortality rate of psych D/O 2. Dx: High index of suspicion, screen with SCOFF (Sick, Control, One stone/14 lbs, Fat, Fear)- 2 or more suggests Eating Disorder 3. Complex pathophysiology: dysrhythmias, CMP, re-feeding, osteoporosis, GI, neuro, etc 4. Dispo- involve social work & psych or ensure good follow up. Admit if abnormal vs, syncope, electrolyte derangement, Suicidal Ideation ![]() Case 1: Tattoo Reactions
Case 2: Missed Central Cord Injury in Intoxicated Motor Vehicle Collision
Case 3: Secondary Syphilis
Case 4: Osteomyelitis in Adolescent
Case 5: Guttate Psoriasis
![]() Wounds over knuckles = fight bites
Pain out of proportion
Injection Injury
Sudden calf pain
Maisonneuve fracture
Knee dislocation/relocation
![]() Pediatric Cervical Spine Injuries Anatomical considerations include: - Head-to-body ratio significantly larger than adult patients - High ligamentous laxity, underdeveloped paraspinous muscle development - Increased force on fulcrum between axial spine and skull Rare but dangerous: seen in less than 1% of pediatric blunt trauma 2011 PECARN Annals article lists 8 risk factors: - High mechanism, diving injury, AMS, focal neurologic deficit, neck pain, torticollis, major torso injury, predisposing factors Sepsis Masquerade
- Remember that an elevated lactate does not equal sepsis - Lactic acidosis spawns an extensive differential - The Emergency Department is high risk for medical error o Are you anchoring? o Will your diagnostic inertia negatively affect your patient? o Is premature closure limiting your differential? - Remember to take your diagnostic pause Spontaneous Bacterial Peritonitis
- defined as infection of ascitic fluid with no obvious surgically removable source - high mortality - 40% at first onset, 70% two year mortality - usually caused by translocation of gut bacteria, GNBs ( E Coli) or GPC (streptococcus sp. etc) - Consider in ALL cirrhotics! - Check for ascites with U/S if you have to. Abdominal Paracentesis: - Paracentesis has very low 5% risk of bleeding which can be avoided by ultrasound - Only 0.6% risk of infection from bowel injury during the procedure or iatrogenic introduction - Fluid Labs: order protein, count, gram stains and culture -The count is what counts. % segs x total nucleated cells = absolute PMN count > = 250 cells per mm3 -gram stain is highly inaccurate with 40 % FP rate -culture is also only positive 40 % of the time -culture negative neutrophilic ascites and SBP should be treated the same Treatment: - Antibiotics : Ceftriaxone 2g per day or Cefotaxime 2g per 6 h - Albumin : 1.5 g/kg in first six hours and 1 g/kg on day 3 Renal Dysfunction: - high correlation with mortality - hepatorenal syndrome - type 1 is acute and more lethal - Reduction in mortality from 29% to 10% with use of albumin SBP Prophylaxis : in GI bleeders, those with previous SBP and also those with low protein ascitic fluid and no history of SBP ![]() 1. Keep a low threshold for CT scanning in elderly patients with abdominal pain. 2. Cannot rule out acute mesenteric ischemia with labs alone. 3. Adequate resuscitation and IV antibiotics may prolong reversible ischemia time. 4. Keep AMI high in your differential diagnosis as mortality approaches 100% if missed. 5. CTA is much better than CT with IV and PO contrast (95% sensitivity vs. 83% sensitivity) if highly suspected. |
Archives
August 2018
Categories
All
|