ED Rounds – June 2015

Thanks to Dr Emily Love for preparing this useful post that summarizes the ED Rounds presentations for June 2015.

Resident Elective to South Africa.

Dr Leanne Hewitson and Dr Sarah Compeau

This was a great presentation. The girls talked about their work in several different hospitals in South Africa where they had an opportunity to assess and treat a large volume of trauma patients. In terms of some of the ways these hospitals differed from ours, there were often less resources (for example, there would be only so many suture trays for the night and they had to be careful not to use these up unnecessarily; also there were only two bags of O negative blood in the department in one of the hospitals – if they needed more they had to call a driver who would transport the blood from a facility 45 mins down the road).  

Another difference was staffing. There typically was not an attending staff on site, and they had a lot of independence in terms of diagnosing and treating their patients. they worked closely with a junior resident, a medical student and a senior physician who was not yet an attending (I can’t remember the name they assigned to this role).

Examples of hands-on opportunities: chest tube insertion, assessing and treating stab wounds and patients with multiple traumas

In terms of the discussion after the presentation, we talked about safety. In one of the cities, it was not safe to go out alone at night and was necessary to always have a route planned out so they would not get lost and end up in a dangerous area. The girls did feel  that with good planning and proper cautions the benefits of the experience outweighed the risks.  

Hands on experience: We talked about how valuable this experience was in terms of seeing a large volume of trauma patients, which we don’t see here in Canada. The girls both feel they are much more comfortable treating trauma patients here after their experience and would recommend it to other residents.

Teaching residents in other centers: Sarah and Leanne were able to both learn from house staff at the hospitals and also share some of their own skills. For example, they were able to teach ACLS protocols to the residents at one of the centers as they did not have formal  ACLS training as they did here.

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ST elevation in a 33 year old in RAZ

Dr Nicola Smith

This was a very interesting prevention and a good lesson to all of us on recognizing our own biases that may affect patient care.

When a 33 yo otherwise healthy female presented to RAZ with a headache, some potential biases were as follows

1- the triage note mentioned that she was quiet anxious but had settled

2-  she was in RAZ which gives the impression the patient is not acutely ill

3- it was the end of the day after a long busy day

The resident who saw this patient recognized these biases, and spent time with her to do a thorough history and physical. She was prompted to order an ECG which showed the ST elevations when the patient spoke about pain starting in her abdomen and moving up to her head and also left arm numbness.  

the patient turned out to have a pheochromocytoma. Lessons we learned about this are as follows:

1- close blood pressure and HR control are key before any surgery as there is a risk with surgery of further release of catecholamines and  a hypertensive emergency

2- these patients need close work-up for MENS syndromes

3 – there are some case studies reporting ST elevations in pheochromocytoma.

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