MediMike Posted November 27, 2020 Share Posted November 27, 2020 44 minutes ago, EMEDPA said: We have just the opposite problem. They cath everyone. The first cardiologist I called about this was wondering why I called because they felt it was an "obvious inferior stemi in evolution", while myself and the ED attending thought great story, worrisome, but not slam dunk EKG. At least they didn't want to give her TPA before we shipped her. I felt that might have been over the top given no pain and nl trop #1 and no change in ecg at 30 min post #1. yes, she got heparin and plavix. I was on board for that. Slam dunk huh? Makes me feel better about my reading skills. Don't suppose there was a prior ECG in the system anywhere? Did you check a myoglobin? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 27, 2020 Author Moderator Share Posted November 27, 2020 21 minutes ago, MediMike said: Slam dunk huh? Makes me feel better about my reading skills. Don't suppose there was a prior ECG in the system anywhere? Did you check a myoglobin? no prior ekg available. have not checked a ckmb or myoglobin in years. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 30, 2020 Author Moderator Share Posted December 30, 2020 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 30, 2020 Author Moderator Share Posted December 30, 2020 above pix from my phone. can't add text for some reason. known covid +. walked in with sao2 40% on RA. 78% on NRB. failed bipap. intubated, central line, transfer. Quote Link to comment Share on other sites More sharing options...
Randito Posted December 30, 2020 Share Posted December 30, 2020 The bases in the second photo look marginally better, is that just from improved atelectasis with the addition of some PEEP? 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted December 30, 2020 Share Posted December 30, 2020 16 hours ago, EMEDPA said: above pix from my phone. can't add text for some reason. known covid +. walked in with sao2 40% on RA. 78% on NRB. failed bipap. intubated, central line, transfer. I've had the same issue. Walked in at 40% huh? I've had a couple folks who are just hanging out in the 80s and I just let them hang. The "happy hypoxic" phenotype is a lot more rare than was initially billed but it's pretty neat to see it in action. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted December 30, 2020 Share Posted December 30, 2020 I've seen lots, usually in the 55+ population, that are speaking easily when lying in the bed at sats in the 80's but plummet even when transferring to a bedside commode. The progression I'm seeing is: 1st ED visit: some COVID s/s but not hypoxic, d/c home 2nd ED visit: usually 2-5 days after 1st. Now dyspneic on exertion, hypoxic but easily corrected with 2-4 lpm NC. Med-surg admision, dexamethason, remdesivir. 2-4 days later on the floor: after progressing through NC, high-flow NC, mask, and self-proning gets BiPap'd & transferred. LONG stay at receiving hospital, often weeks If intubated, long ICU stays. If survive, d/c to some sort of ECF for long, slow rehab. These folks are around my age, not necessarily with massive comorbidities. Very scary. 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 31, 2020 Author Moderator Share Posted December 31, 2020 On 12/30/2020 at 8:33 AM, Randito said: The bases in the second photo look marginally better, is that just from improved atelectasis with the addition of some PEEP? yes, likely Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 31, 2020 Author Moderator Share Posted December 31, 2020 21 hours ago, ohiovolffemtp said: I've seen lots, usually in the 55+ population, that are speaking easily when lying in the bed at sats in the 80's but plummet even when transferring to a bedside commode. The progression I'm seeing is: 1st ED visit: some COVID s/s but not hypoxic, d/c home 2nd ED visit: usually 2-5 days after 1st. Now dyspneic on exertion, hypoxic but easily corrected with 2-4 lpm NC. Med-surg admision, dexamethason, remdesivir. 2-4 days later on the floor: after progressing through NC, high-flow NC, mask, and self-proning gets BiPap'd & transferred. LONG stay at receiving hospital, often weeks If intubated, long ICU stays. If survive, d/c to some sort of ECF for long, slow rehab. These folks are around my age, not necessarily with massive comorbidities. Very scary. What we are seeing is this: Asymptomatic screen + from large workplace screenings. sent home to quarantine one week later looks like death warmed over and crashing. generally arrives by private vehicle with sao2 < 75% 1 2 Quote Link to comment Share on other sites More sharing options...
jmj11 Posted January 1, 2021 Share Posted January 1, 2021 It will be fascinating, while tragic, some day to know exactly why the diverse outcomes of this strange disease. It is beyond comorbidities, while they contribute. 1 2 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 1, 2021 Share Posted January 1, 2021 And people still don't take it seriously until the poop hits the fan and THEY become the patient and then it's "You have to save them". Ugh... 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 1, 2021 Share Posted January 1, 2021 14 hours ago, jmj11 said: It will be fascinating, while tragic, some day to know exactly why the diverse outcomes of this strange disease. It is beyond comorbidities, while they contribute. I sure wish there was better data currently available on this. I've seen some of the models, but my "risk stratification" is pretty much the same as seeing how the patient is doing over time. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 6, 2021 Author Moderator Share Posted January 6, 2021 Name the findings and predicted course. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 6, 2021 Share Posted January 6, 2021 Patellar tendon avulsion fracture. Predicted course: pain control, immobilization, lots of quality time spent with the orthopod du jour, including addition of some after-market hardware in the knee. 1 Quote Link to comment Share on other sites More sharing options...
TheFatMan Posted January 6, 2021 Share Posted January 6, 2021 Tibial tuberosity fracture type 2B (3B?). Call ortho for ORIF. NWB in cast for 4-6 weeks. Rehab for 3 months. Alternatively - give them Motrin and tell them to change their socks. 1 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted January 6, 2021 Share Posted January 6, 2021 Ouch. Long. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 7, 2021 Author Moderator Share Posted January 7, 2021 Patellar tendon rupture with comminuted avulsion fx of tibial tuberosity where the tendon tore off. Transferred to regional pediatric hospital after review with peds ortho for repair. The concern is that ongoing bleeding in the joint may result in compartment syndrome. This pt had no evidence of that. This was a high school basketball player who landed wrong after a dunk. 1 Quote Link to comment Share on other sites More sharing options...
jmj11 Posted January 8, 2021 Share Posted January 8, 2021 Nice photo. Haven't been around orthopedics in a very long time, but was easy to figure out due to good quality of photo. Sometimes the photos on line look to me like a Rorschach test. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2021 Author Moderator Share Posted March 29, 2021 Fussy two year old. Thoughts? Quote Link to comment Share on other sites More sharing options...
TheFatMan Posted March 29, 2021 Share Posted March 29, 2021 Pneumoperitoneum See if the surgeon is awake? 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2021 Author Moderator Share Posted March 29, 2021 16 minutes ago, TheFatMan said: Pneumoperitoneum See if the surgeon is awake? Getting the CT first, but yeah...think we are headed that way. Quote Link to comment Share on other sites More sharing options...
TheFatMan Posted March 29, 2021 Share Posted March 29, 2021 12 minutes ago, EMEDPA said: Getting the CT first, but yeah...think we are headed that way. Any more history? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 30, 2021 Author Moderator Share Posted March 30, 2021 3 hours ago, TheFatMan said: Any more history? fussy with diarrhea. Holding abd. afebrile with stable VS and unimpressive exam and nl labs. CT abd/pelvis actually was read as normal. So, that plain film fooled me, my attending, and a radiologist. 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted March 30, 2021 Share Posted March 30, 2021 1 hour ago, EMEDPA said: fussy with diarrhea. Holding abd. afebrile with stable VS and unimpressive exam and nl labs. CT abd/pelvis actually was read as normal. So, that plain film fooled me, my attending, and a radiologist. Funny, I saw that and immediately thought the same. Wonder if that section of bowel just lined up perfectly behind the diaphragm and is giving the appearance of free air? 1 1 Quote Link to comment Share on other sites More sharing options...
TheFatMan Posted March 30, 2021 Share Posted March 30, 2021 18 hours ago, EMEDPA said: fussy with diarrhea. Holding abd. afebrile with stable VS and unimpressive exam and nl labs. CT abd/pelvis actually was read as normal. So, that plain film fooled me, my attending, and a radiologist. Wow! That is interesting. Great case, thanks for sharing! Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.