Conference Notes: 2/3/21

Intern Lightning Lectures – Schutzman, French, Strohmaier

  • Positively electrifying.
  • Acid-Base Status
    • Bicarb vs respiration vs buffers control pH
    • Delta gap in context of AGMA  – (AG-12) – (24-Bicarb)
      • Normal -6 to +6
      • Can indicate AGMA +NAGMA superimposed or vice versa.
  • Unstable C-spine fractures
    • Denis Column Concept
      • Anterior column – always stable
      • Middle column – sometimes stable
      • Posterior column – always unstable
    • Jefferson’s Fracture
      • Consider vertebral artery injury
    • Bilateral Facet Dislocation
      • Consider CTA C-spine, MRI may be warranted as SCI strongly associated
    • Odontoid Fracture
      • Types I, II, III
    • Atlanto-Occipital Dissociation
      • Calculate that Power’s ratio, folks.
    • Atlanto-Axial Dislocation
      • Remember increased likelihood in some populations; Trisomy 21, OI, Marfan, NF1, SLE, AS, psoriasis, RA
    • Hangman’s Fracture
      • C2 fx with anterior displacement
    • Flexion Teardrop
      • Can disrupt posterior longitudinal ligament, high association with anterior cord syndrome
  • DRESS vs SJS vs TEN
    • DRESS – drug rash with eosinophilia – morbilliform rash
      • Remember herpes reactivation
    • SJS/TEN
      • Mucosal involvement

Can’t Miss EKG Review – Huecker

  • Didn’t miss a beat.
  • Read Amal Mattu. If you don’t, you won’t understand EKGs very well
  • He’ll send out his presentation

Test Taking Strategies – Shreffler

  • 225 multiple choice questions, 4.5 hours to complete
  • Feel okay to change answers after you re-read questions; you will likely have more insight later on.
  • He will send out his presentation

Headaches in Small Groups – Nichols

  • HA1
    • Temporal Arteritis
      • Get ESR, can do US vs MRI, will require temporal artery biopsy
      • Ophtho involvement means a larger burst x3 days of methylprednisolone, likely requires admission
  • HA2
    • CO poisoning
      • Need ABG with co-oximetry
      • Consider EKG and troponin
      • Remember fetal Hb binds CO much more preferentially than maternal Hb, so lower threshold to treat with hyperbarics.
  • HA3
    • Epidural hematoma
      • Consider BP goals, mannitol/3%, elevate HOB, hyperventilate

Procedural Review – Baker

  • Excellent multiple choice questions.
  • SBP
    • Remember albumin, get abx early
    • Low thresholds for diagnosis with cell count greater than or equal to 100 in peritoneal dialysis
    • We need to do more paracentesis
  • LP
    • Watch that bevel
    • Platelets > 20/25, INR >=1.5
  • Pacemakers
    • RIJ
    • Transvenous: 80 BPM, 20mA, 20cm
  • Thoracotomy
    • >1500 initial output, >200mL over first 3 hours
    • 5th intercostal space
  • Yolk sac + gestational sac required for confirming IUP earliest.

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