Conference Summary 9/15/21

September 15, 2021

Residency news and updates:

  • October 27th will be a reverse conference with scavenger hunt. Princess shift will be from 7am-12pm, conference will be afterwards around the boardwalk.
  • 7a: Resident Lecture – Brenda – Harlem Trauma Diaries / Faseeh – CCU EKG lecture #1
  • 8a: Dr Rizzo – Radiology Rounds
  • 9a: Dr Cocchiara – ED Trauma Management
  • 10a: Dr Nguyen – The Eye (part 1)
  • 11a: Med student lectures: Tanzeela – Seizures / Tanzina – Sickle Cell pain crisis

Resident Lecture – Brenda – Harlem Trauma Diaries

  • Always ABCDE
  • Case 1: 40M Stab in neck and laceration to right UE with tourniquet
    • Screaming “I can’t breath”
    • Classically: Zone 2 = OR
    • CTA everybody if stable, if platysma violated
    • Hard signs = Go to OR
  • Became hypotensive/tachycardia → started MTP
  • Case 2: 23M “jumped over bunch of garbage cans”
  • Case 3: 80M huge hematoma side of face
    • IOP = 60
    • Complete visual loss within 60-100 mins
    • Indications for lateral canthotomy:
      • IOP >40
      • Proptosis
    • Contraindications:
      • Globe rupture

Faseeh – CCU EKG lecture #1

  • STEMI vs OMI
  • Dr. Smith’s ECG Blog: The OMI Manifesto
  • STEMI criteria (70% sensitivity for occlusion, doesn’t include STEMI equivalents which can benefit from reperfusion)
  • ER physicians more sensitive at calling STEMI
  • ECG changes in ACO
  • Wellens syndrome: DO NOT stress test (they have critical LAD stenosis which → MI), go straight to cath lab 
  • Spodick’s sign: downsloping TP segment, esp in II, seen in ~30% pericarditis
    • “Witting found that Spodick’s sign occurred in 29% of patients with pericarditis and 5% of patients with STEMI” (LIFTL post)
  • Benign Early Repolarization: 
    • Fish-hook pattern esp in V4, very typical, BER findings more prominent when bradycardic
    • , 
    • T wave will be more prominent than STE
    • Concave ST segment
    • Asymmetrical T wave
    • No Terminal QRS Distortion 
      • Absence of both an S wave and J wave in either of leads V2 or V3
  • Left Ventricular Hypertrophy: voltage criteria and one non-voltage
  • STE > 20% of QRS complex then OMI in LVH – STEMI criteria not sufficient in severe LVH

Dr Rizzo – Radiology Rounds – Upper Extremity XRs

  • Scapula fracture = rare = 1% of fractures
    • Associated with high velocity trauma
    • Palpate scapula on elderly FOOSH injuries
      • Scapula fracture.. Now look for neurovascular injuries and other injuries
    • Check if violate glenoid fossa, may need ORIF
  • Scapulothoracic Dissociation
    • Laterally displaced scapula with an ipsilateral clavicular fracture, AC joint separation or sternoclavicular joint disruption
  • Clavicle fracture
      • Neonate, clavicle fx 2/2 breech delivery
      • Fetal Macrosomia
      • Check for brachial plexus injury
      • Mid-clavicle fracture plus pneumothorax
  • Humerus fractures
    • Humerus ossifications centers: complete at 13-14
    • 3rd most common bone that elderly fracture
    • OR indications – for proximal humerus fractures
      • Comminuted fractures
      • Greater tuberosity fractures (w/ displacement or angulation)
    • Test Axillary nerve, check sensation/motor
      • Look for radial nerve injuries and wrist drop
      • U-shaped splint with sling; 
      • OR indications: angulation > 20% or comminuted
  • Elbow fractures
    • Radial head most common in adult
    • Supracondylar most common in pediatrics
  • Look for posterior fat pad and and sail sign
    • Anterior fat pad sign + posterior fat pad
    • Capitellum fracture -> rare FRX
    • Posterior long arm splint
    • Olecranon fracture
    • Older than 70, younger than 30?
    • Ulnar nerve injury concern – assess with grip strength and sensation of 4th and 5th digits
    • Posterior elbow dislocation
    • Most common dislocation of elbow
    • Reduce by traction/countertraction
      • Tip: pt prone with arm hanging, and downward traction from wrist
      • You can use saline bags/weights tied to wrist
    • Essex-Lopresti: characterized by a fracture of the radial head, dislocation of the distal radioulnar joint and rupture of the antebrachial interosseous membrane
    • Interosseous membrane disruption causing forearm instability, pt won’t be able to pronate and very weak grip strength
  • Nightstick fracture: isolated ulnar shaft fracture, defense injury, high chance of compartment fracture
    •  
  • ALWAYS get more than 1 view if possible – in any xray

Dr Cocchiara – ED Trauma: Part One

Dr Nguyen – The Eye (part 1)

  • Vital signs of the eye
    • Pupil
    • EOM
    • Visual acuity (download Eye Chart app or use MDcalc Snellen)
      • Rosenbaum: 36”, Snellen 6’
    • Visual field
    • IOP
  • Ocular US: 
  • Visual Field Deficits: Identify the lesion
  • Eye pain DDx: GCA, DM, Migraine, Sinusitis, Shingles, Ischemia, Neuritis
  • Case 1: 70F pmhx HTN, DM, smoker presents with headache + vision changes
    • Intermittently sees black from left eye for a few seconds, happened 2 weeks ago too
    • Fever prior night, body aches, left eye complete blackness resolved (amaurosis fugax)
    • +TTP @ left temporal artery, pulseless temporal artery
    • ESR = 110, CRP elevated
    • Dx: Giant Cell Arteritis
    • Tx: “Rule of 50s”
      • 50 years old
      • ESR >50
      • Prednisone 50mg daily
    • If there is vision loss → Solumedrol 1000mg IV, biopsy, admission
    • Amaurosis fugax = TIA of the eye
  • Case 2: 31F no pmhx headache with blurry vision
    • Obese and gave birth 1 year ago
    • Pain with EOM
    • Red desaturation test is positive
    • Ocular US = optic nerve sheath swelling (>5)
    • Dx: Optic neuritis
    • Tx: Solumedrol 1000mg IV for 3 days, consult optho/neuro, admit
  • Case 3: 28M headache + pressure behind left eye, recent URI
    • +fever, congestion for 12 days, anosmia, +periorbital edema
    • Vital signs of eye = normal
    • Dx: Sinusitis
    • No indication for CT, clinical diagnosis
    • Treatment
      • <10 days = tylenol/motril, nasal irrigation, flonase, decongestant
      • >10 days = Augmentin or doxycycline
  • Case 4: 64 yo M HA, blurry vision, photophobia
    • Blurry on L side of his face, vesicular rash, fever, red in L eye (conjunctivitis)
    • Eye VS = normal
    • Labs: not really, just for admission
    • Imaging: not necessary
    • Wood’s Lamp: Dendritic lesions
      • Varicella pseudodendrites – not as connected
      • HSV: dendrites
    • Vesicular Rash in V1 distribution of trigeminal (V)
    • Dx: Herpes Zoster Ophthalmicus
    • Tx: Rash < 1 week then acyclovir, famciclovir, or valacyclovir & Discharge
      • Immunocompromised then admit
    • Ramsay Hunt Syndrome = Lesions on ear or face
    • Huchingsons sign = lesion on the nose

Student lecture – Tanzeela – Seizures

  • Lateral tongue bite = very specific for seizure
  • Status epilepticus
    • >5 minutes
    • Another seizure without return to baseline

Student lecture – Tanzina – Sickle Cell Crisis

  • Don’t miss stroke, splenic sequestration, acute chest syndrome, priapism
  • Treat pain
  • Indications for stem cell transplant:

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