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
  • 5^th intercostal space
• Yolk sac + gestational sac required for confirming IUP earliest.