Conference Summary 7/28/21

July 28, 2021 , , ,
  • 7a: Resident Lectures: Eugene – Steroids / Hamzah – Non-traumatic vision loss (both really cool topics)
  • 8a: Dr Sun – Hyperkalemia / Mike Cyd – CCU/EKG lecture #1
  • 9a: BREAK / TJ – SIM LAB
  • 10a: TJ – SIM LAB
  • 11a: TJ – SIM LAB
  • QA with Dr. Kindscuh
    • Talked about some recent cases with potential lawsuits
    • Methadone OD should get ICU consult and at the very least admitted for tele for 24 hours
    • GI code
      • Rockall score >10% → go to resus room
      • GBS score >50% → get GI fellow down
    • We will be switching from alteplase to tenecteplase
    • SEPSIS code, call them more often, we need more data
    • Don’t use oral contrast for CTAP unless it is indicated
      • Appy with BMI <20
      • Low grade SBO (c/i in high grade → nausea/vomiting/aspiration)
      • Intraabdominal abscess 
    • New interpreter devices for cyracom are available
    • Breezy point event August 11 (dress code business casual)
  • Hamzah – Non-traumatic vision loss
    • All patients require: Visual Acuity, Pupils, Confrontational Visual Fields, EOM, IOP, CN exam, POCUS (NOT in globe rupture)
    • Hamzah’s case: Pt with Central Retinal Art Occlusion
    • Painless: Retinal Detachment, CRAP, CRVO, Giant Cell Arteritis
      • GCA 
        • (must have 3 of 5 to diagnose): >50yo, temporal artery tender, ESR >50, headaches, (+biopsy)
        • Tx: ROIDS (Methylprednisolone 1000mg QID x3 days) 
      • Retina detachment
        • Sudden painless, flashes/floaters, “curtain”
        • TJ tidbit: If macula on, then vision can be saved if surgery within 24hrs
        • POCUS is Dx test of choice in ED
      • CRAO
        • “Cherry red macula”
      • CRVO
        • “Blood and thunder”
      • CRAO vs CRVO
  • Painful: Glaucoma, Uveitis, Optic neuritis
    •  Acute Angle Closure Glaucoma
      • Hazy Cornea, fixed irreg pupil
      • IOP >40
      • MEDS: Timolol (BB), Pilocarpine (causes meiosis)
      • POCUS: 3×5 rule for ICP elevation, may be extrapolated to IOP(?)
    • Iritis or Anterior Uveitis (not just bilateral conjunctivitis)
      • Ciliary flush
      • Pain >> normal
      • Management: Cycloplegics (atropine), steroids, Ophtho f/u in 24 hours
  • Eugene – Steroids
    • Sepsis case, IVF + pressors not working… Next step? Steroids
    • Steroid Effects:
    • Point/Counterpoint from PulmCrit on Steroids in Septic Shock
    • 5 half lifes for any drug to be eliminated
    • Steroids Indicated in bacterial meningitis → SPECIFICALLY Dexamethasone
    • 2-3 weeks of hydrocortisone to get adrenal suppression from steroid use
    • Solumedrol vs Hydrocortisone? Hydrocortisone has both mineralocorticoid and glucocorticoid activity 
  • Dr Sun – Hyperkalemia
  • Mike Cyd – CCU/EKG lecture #1
    • Bradycardic patient, HR 30s, BP 140/80
    • DDx for bradycardia: HE DIE “hypothermia, endocrine, drugs, ischemia, electrolytes”
    • BB vs CCB toxicity? 
      • BB = hypoglycemia
      • CCB = hyperglycemia
  • TJ – SIM LAB
    • ATLS SIM
    • 57M fell off a 7 foot ladder, unwitnessed
    • ABCDE
    • Hypotensive/bradycardic = neurogenic shock
    • Neurogenic shock
      • 1st line pressor = norepi
      • MAP target = 85 (not 65 like sepsis)
    • If worries about neck trauma and pt is in a c-collar intubate with glide.
  • Oral boards cases with Geoff
    • Case 1
      • 72M ICD constantly shocking patient, EKG shows WCT consistent with Vtach, treated with procainamide or amiodarone 
    • Case 2
      • 34M palpitation and lightheadedness after cocaine use, EKG showed SVT, treated with adenosine, had a seizure which resolved with Ativan, then Vtach (WCT)
      • Cocaine toxicity wide complex tachycardia is treated with 2-4 amps sodium bicarbonate (against ACLS protocol) 
      • Amio may work but procaína mide will increase sodium channel blockade and cause torsades as cocaine is a sodium channel blocker  

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