Conference Notes 8-23-2011
ORAL BOARDS ANDREJ and GROMIS
2.Orbital Cellulitis in an infant
Hemorrhagic shock class 1= 750ml, class 2= 750-1500ml, class 3= 1500-2000ml, class 4 =more than 2000ml
Lethal triad=acidosis, hypothermia,coagulopthy
Hemostatic Resuscitation for penetrating trauma with short transport times get blood pressure to MAP of 65
Crystalloid only for keeping pt alive until they get blood.
For large blood loss shoot for ratio of 1 unit prbc's:1 unit of ffp and possibly 1 unit of platelets.
Be extra thorough with trauma transfers and sign outs.
Call for blood early
Fentanyl is a good analgesic choice for the hemodynamically unstable
AFIB CINDY CHAN
Agents for pharmacologic conversion of afib all lengthen the QT interval. So caution warranted. Amio, Ibutalide, Propafenone. Procainamide is another good choice.
To reduce stroke warfarin reduces risk by 64%. Asa instead of wrfarin is less effective but does reduce risk of stroke by itself. Dabigatran (Pradaxa) is a direct thrombin inhibitor. Expensive alternative to warfarin. Indicated in non valavular/non renal/non liver disease related afib. Anecdotal stories from audience relate experiences with severe bleeding.
SAH and CEREBRAL VASOSPASM LAURA
Blood sugar >200 increases risk of vasospasm
GCS can predict vasospasm. The lower the score the hihger the risk of vaspasm. SIRS also predicts vasospasm and overall poor outcome. 2 SIRS criteria gives you a 9.1 OR for vasospasm and poor outcome. Elevated troponin also increases risk of mortality.
LIFE AFTER RESIDENCY MIKE ANTONIS
Detorsion of testicular torsion can buy you time to pt to OR.
Groups in desirable cities like chicago/boston/denver will likely pay less than groups in less desirable cities.
Hook Effect or Prozone Effect falsely low values on immunoassay due to extremely high levels of antigen. Molar pregnancy was the example. Pt has a beta-hcg of greater than 1million and had a negative ucg.
Develop a track record with your group to allow you to negotiate from a position of strength on your contract.
Evaluating meta analyses; Strict inclusion/exclusion criteria, include valid studies (RCT's best), the included studies and their results should be similar, Funnel Plot make the results more trustworthy