Hello everybody, today we have a very interesting case for you (that was send to me by one of my great collegeaus and friends working in the Netherlands!) Sadly the forensic pathologist had to give the diagnosis, which is always a bad sign.
An 80-year old man came to the ED during a nightshift, after falling a few steps from the stairs. He was complaining of neck and back pain, pain in his left elbow and in his right wrist. It was uncertain if he had fallen on his head, but he had no loss of consciousness. Because he used marcoumar a CT-scan of brain was ordered which showed no traumatic brain injury. The CT-scan of neck, thorax and abdomen showed 2 vertebral fracture from C4 and T2 and 3 ribfractures (#1, 2, 7) on the right side with no pneumo-/hematothorax or vascular injury. In the thorax or abdomen no free fluid was found. In the extremities there was also afracture of the left elbow.
Publication from our collegue in the International Journal of Emergency Medicine today.
Conclusion: This study shows that EPs are significantly more present in larger EDs and in EDs where there is more continuing professional education and where there are more clinical audit activities. Our findings suggest that the presence of emergency physicians is positively associated with the quality of emergency care, but prospective research is required to examine causality.
Hello everybody, Finally the presentation about PE…and you know, I love PE when I have a patiënt with a Hamptons Hump or a EKG wit typical PE-changes or a patient that dropped down with a SpO2 of 80%. But I really hate these patient with a mild cought and low fever, dripping nose and oooo yeah some mild pain while breathing. What do you think the internist or pulmonologist wants….a D-dimer! And why??? what do they want to find in this patient with a viral infection….a small subsegmental PE probably! That’s is why I thought it is time to tell everybody that PE is NOT as deadly as we thought….at least most of the time!
Off course I know people die of PE, but I really think that this is a small group and we are not treating our patients properly if we (the doctors) are to scared an start sending D-dimers for every patient with a cold!
Ok…enjoy the 20-minute PPT presentation , which you can use whenever and wherever you want! Let me know if you have any comments!
Welcome back to EMDutch and GMEP Friday! At first I have to apologies for 2 things. 1.) Still no post about PE…I know, but I have to work 6 days this week + 1 day with the kids, so the post had to waith. 2.) Their were 2 correct answers in the question from last week, which was: What does alcoholic ketoacidosis have in common with diabetic ketoacidosis? The correct answers were a Kussmaul respiration, but also a low serum insulin level. This means that 13/14 were correct! Great job!
Now the case + question for this week. First the case. (First take a look and the picture and see if you know what is wrong!)
The answer of last week was A: a pneumomediastinum does NOT always need a chest drain! 13/17 were correct!
Hope to see you next week! In the meantime the post “PE not as deadly as we think” is coming. It takes some more time since I am going to post it in a PPT which you all can en may use in your own hospital or for whatever reason you want.
HAVE A GREAT WEEKEND!
P.s. tell all your collegeaus about GMEP.org! Help build the greatest database out there!
Video night Essentials 2012June 5, 2013 at 19:00 – 23:00Amsterdam, at my homeIk ga aan mijn Essentials Of EM Digital Package 2012 beginnen. Vier congresdagen online te bekijken wanneer het uitkomt. Woensdag 5 juni zal ik beginnen met dag 1, en daaruit de meest interessante voordrachten k iezen om savonds te bekijken onder het genot van een hapje en een drankje.\