Grand Rounds Recap


We have another great day of conference coming up tomorrow, but first…let’s recap last week!

Dr. Stuart Swadron discussed chest x-ray in the ED:
  • Hemothorax is easy to hide in a supine patient
  • COPD exacerbation can be mimicked by pneumothorax, PE, and lobar collapse
  • “Things people call pneumonia”: PE, septic emboli, TB, cancer, and diffuse alveolar hemorrhage

Nick tweet

Dr. Billy Mallon discussed necrotizing fasciitis:

Mallon tweet

  • Other worrisome signs:  skin necrosis, bullae, shock, dishwater drainage, tense edema, and bronzing.  Beware!  Often it will present early and subtly.
  • MRSA is the classic cause, but group A strep, Clostridia, Vibrio, and polymicrobial infections are also common
  • The LRINEC score has mixed literature, but a high WBC and low sodium should make you suspicious
  • Initiate antibiotics, but surgery is the most important therapy, so call early
Dr. Neil Rifenbark updated our PEA thought process

carl tweet

  • New approach: two steps
    • Wide or narrow?
    • If narrow, do a RUSH exam
  • Caveats:
    • MI, PE, and pre-existing BBB can all present as wide-complex
See you tomorrow for:

History of LAC+USC with an alumni guest panel, hosted by Drs. Tabatabai and Mallon
Morbidity and Mortality Conference
Save of the Month

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