Louisiana state university health science center new orleans emergency medicine residency program policies to supplement lsuhsc house officer manual



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M & M Presentations

The following will be presented in a PowerPoint Presentation.


This is a “Question – Answer” case with HPI, H&P, Labs, ED course:
First Slides: HPI, Physical exam

The first question: What is the differential diagnosis?


Other questions: (Diagnostic) What tests would you order?

(Management) Appropriate actions would include?
Second Slides: Course of action, what happened to the patient.
Presenting resident will summarize the case
At this point a member of the audience will be ask to critique the management of the case. Was this the proper course of action?. Would you have done something different?. Why?.
Last Slides: two questions: (Clinicopathologic questions) Referenced,

relevant and pertinent question to the case

presented. (No true or false, No all the above.)

In A, B, C, D, E best single answer format.


Example:
64 y/o Hispanic male arrives to the ED c/o Left flank pain of sudden onset of one hour duration. PMH.   Left kidney stone 2 yr. ago. and Hypertension. Social   Smoker 1 ppd x 30 yr., retired. Meds.   blood pressure meds. NKDA. PE   BP 90/60, 72, 98.2, 26. The patient appears in severe pain, can't get comfortable on the stretcher. HEENT   Gr II HTN retinal changes, Neck   no JVD, Lungs  Clear, Heart   rr, no murmur, Abd.   diffusely tender, quiet, Rectal   neg hemetest. Pulses   1+ Symmetric.
Q. #1. Differential Diagnosis:

Nephrolithiasis

Diverticulosis

Ruptured Viscus

Leaking/Ruptured AAA

Ischemic Bowel


Q. #2 Diagnostic: ABC"s EKG

IV x 2   Fluid bolus, Labs

02 high flow

Q. #3 Management:
Stat Surgical Consult
Clinical course: (Presenting Resident) This patient was admitted to the monitor cubicle, primary assessment, IV x 2 started, blood drawn for CBC, Chem., high flow 02, cardiac monitor, Secondary assessment. Pressure support with Dopamine, IV fluids. A CT scan of the Abdomen was done 1 hour latter. The patient was taken from the CT table to Surgical OR due to the patient's clinical deterioration and died while in Surgery.
Audience Critique: (Designated by Staff Present or Chief Resident) After initial resuscitation of the patient and the initial ancillary tests this patient should have been moved to the OR for immediate Surgical intervention. Even Though the mortality of a ruptured AAA is over 80% this patient could have had a better chance if there would not have been a delay in administering pressure support drugs and obtaining a CT scan.
Q. #4 Clinicopathological:
1.) The most common presentation of AAA is?
a. painless, pulsatile mass found on routine exam

b. tearing flank pain, like kidney stone

c. patient usually dead on arrival

e. chest pain

f. nausea, vomit and abdominal cramping
Answer: a
2.) Indications for CT in pt's with AAA
a.) unstable patients with no inmediate surgeon available

b.) in differentiating pancreatitis from ruptured

AAA with pt's V S P 130, BP  90/60, R  20

c.) patients suspected of having chronic contained rupture

d.) at surgeon's request for preparative planning

in ruptured AAA

e.) in differentiating AAA vs. appendicitis in pregnant female with history of Hypertension and tobacco use.
Answer c
Ref. Tintinalli, Emergency Medicine   A Comprehensive Guide, 4th ed. ch.59




Medical Records


1. Residents should make every attempt to complete their medical records while the patient is still in the hospital by signing student notes, verbal orders, H & Ps, etc.
2. Medical Records will notify the resident if he or she has delinquent charts. The resident should correct this situation immediately. The hospital' JACHO accreditation is jeopardized by a large number of delinquent medical records. Residents who do not complete delinquent charts within the allowed period will be suspended by the Medical Director without pay.
3. To avoid this, residents should make an appointment with Medical Records to complete these charts immediately upon notification. Residents should not just "drop by" to complete charts or they will have to wait while charts are pulled.


  • Residents are responsible for creating legible medical records that will be useful as documentation for patient care and billing purposes. Residents are required to use their name stamp or to print their name and 5 digit identification number under their signature on all medical records. They should date and time all medical record entries.

  • Medical Records guidelines pertain to all hospitals that EM residents rotate through during their residency.


Electronic Signature

Medical records in Electronic Signature is an official requirement for our residency. This will allow residents to sign any dictated document from any computer. They will not have to come in to the hospital to sign records and they will be able to sign their UH discharge summaries, etc., while rotating at any other hospital. It will be convenient for them and will keep them off the suspension list for delinquent medical records.


Please contact Ms. Jones in medical records to obtain your electronic signature: djones5@lsuhsc.edu


LSU EM Reading Topics 2008-09





  • Topics are all on an 18-month cycle (6 quarters) and have been adjusted for the 2008-09 year; quarter 5 starts July 2008.

  • Subjects are organized by quarter with the number of total pages in parenthesis—You can complete an entire text in an 18-month cycle.

  • Note the bottom of these tables is a list of topics that are fair game for every quarterly exam.

  • All three major ER texts are represented by edition (Tintinalli, Rosen, and Harwood-Nuss). The new Adams text will be added ASAP.

  • This list will also be posted to the LSUEM yahoo group.

  • The national inservice is the third Wednesday of every February (Feb 25, 2009).


QUARTER 5 – July 1st to September 30, 2008

TOPIC

Tintinalli

5th EDITION

TINTINALLI

6th EDITION



ROsen

5TH eDITION

harwood-nuss 3RD EDITION

harwood-nuss 4th EDITION

Neurology

1415-1490 (75)

138-140 (2)

252-256 (4)

1369-1436 (67)

1441-1448 (7)



119-154 (35)

1433-1540 (7)



31-41(10)

961-978 (17)

983-1016 (33)


89-109(21)

574-587(14)

592-631(40)


Neurosurgery

1491-1493 (2)

1437-1440 (3)




252-266 (14)

978-982 (10)



588-592(5)

974-980(7)



Psychiatry

1907-1948 (41)

1807-1846 (39)

1891-1895 (4)

1900-1907 (7)


1541-1582 (41)

2511-2554 (43)

2591-2615 (24)


1104-1119 (15)

1740-1742 (2)



634-653(20)

Abuse and Assault

1949-1966 (17)

1847-1864 (67)

1912-1917 (5)



821-891 (70)

404-409 (5)

1209-1213 (4)

1743-1746 (3)


487-490(4)

1192-1193(2)

1268-1274(7)


Ethics




99-101 (3)

2725-2766 (41)




1807-1812(6)

Dermatology

1571-1608 (37)

1507-1536 (29)

1635-1664 (29)

1078-1103 (25)

656-684(29)

Skin / Soft Tissue

1891-1906 (15)

1769-1806 (37)

737-820 (83)

883-887 (4)

712-717(6)

TOTAL

187

274

373

142

161


QUARTER 6 – October 1st to December 31th 2008

TOPIC

Tintinalli

5th EDITION

TINTINALLI

6th EDITION

ROsen

5TH eDITION

harwood-nuss 3RD EDITION

harwood-nuss 4th EDITION

Pediatrics

749-942 (193)

71-93 (22)

727-908 (181)



82-106 (24)

2218-2397 (79)



1120-1140 (20)

1145-1208 (62)

1214-1332 (118)

1333-1391 (58)



1130-1267(138)

1274-1434(161)



Environmental

1227-1326 (99)

1175-1282 (107)

1972-2062 (90)

2698-2704 (6)



1636-1697 (61)

1720-1780(61)

Hematology

1365-1407 (42)

1319-1362 (43)

48-51 (3)

1665-1700 (35)



1021-1044 (23)

788-822(35)

Oncology

1408-1414 (6)

1363-1368 (5)

1701-1713 (12)

1045-1052 (7)

822-828(7)

Allergy, Immunology, Rheumatology

242-246 (4)

1882-1884 (2)






1583-1634 (51)

2491-2510 (19)



1053-1077 (24)

686-703(18)

TOTAL

346

358

289

373

420



QUARTER 1 – January 1st- March 31th 2009

TOPIC

Tintinalli

5th EDITION

TINTINALLI

6th EDITION

ROsen

5TH eDITION

ROsen

6TH eDITION

harwood-nuss 3RD EDITION

harwood-nuss 4th EDITION

Geriatrics




1896-1899 (3)

2485-2490 (5)

2824-2830


1763-1779 (16)

Subject index p1870

Infectious

Disease

943-1056 (113)

909-1014 (5)

115-118 (3)

1785-1971 (186)



2001-2211


21-26 (5)

888-960 (72)



167-171(5), 174-177(4)

178-185(8)

706-785(80)


Urology

631-654 (23)

606-632 (26)

1400-1432 (32)

1572-1605 1556-1572

267-313 (46)

418-453

Renal/

Acid Base

128-168 (40)

611-630 (19)

655-660 (5)


149-178 (29)

593-605 (12)

633-646 (13)


1360-1399 (39)

1714-1723 (9)



1524-1555

1922-1933



863-882 (19)

453-467(15)

830-835(6)

884-888(5)


Endocrine

1327-1364 (37)

1283-1318 (35)

1724-1784 (60)

1955-1974

1985-2000



813-858 (45)

835-878(44)

TOTAL

237

123

334




205

203


QUARTER 2 – April 1st to June 30, 2009

TOPIC

Tintinalli

5th EDITION

TINTINALLI

6th EDITION

ROsen

5TH eDITION

harwood-nuss 3RD EDITION

harwood-nuss 4th EDITION

Gastroenterology/ General Surgery

497-606 (9)

487-592 (105)

178-218 (30)

1234-1359 (125)



9-11 (2), 147-200 (53)

201-222 (21)

762-812 (50)


340-416(77)

Ophthalmology

1501-1517 (16)

1449-1463 (14)

907-927 (20)

42-74 (32)

112-148(37)

ENT

1518-1538 (20)

1556-1564 (8)



1464-1475 (11)

1494-1506 (12)



928-937 (9)

90-146 (56)

163-195(33)

OMFS / Dental

1539-1555 (16)

1476-1493 (17)

892-907 (15)

75-89 (14)

150-163(14)

Pre-Hospital Care

1-38 (38)

1-60 (60)

2616-2649 (33)

1698-1701 (3)

1708-1712 (4)



1782-1791(10)

Radiology

607-610 (3)

661-668 (7)

1494-1500 (6)

1967-1982 (15)



1865-1890 (35)










TOTAL

138

254

232

236

171


QUARTER 3 – July 1st to September 30, 2009

TOPIC

Tintinalli

5th EDITION

TINTINALLI

6th EDITION

ROsen

5TH eDITION

harwood-nuss 3RD EDITION

harwood-nuss 4th EDITION

Wound Care

281-340 (59)

287-332 (45)




449-459 (10)

912-921(10)

Orthopedics

1739-1881 (42)

1885-1890 (5)



1651-1768 (17)

233-241 (8)

467-736 (269)



223-251 (28)

537-605 (68)



534-572(39)

1022-1099(78)



Procedures

102-117 (15)

124-131 (7)

28-32 (4)

1141-1144 (3)

1762-1768 (6)



43-55(13)

1155-1161(7)



Trauma

1609-1738 (39)

1537-1650 (13)

242-466 (24)

410-448 (37)

460-536 (76)

606-636 (30)


890-1124(235)

TOTAL

160

82

305

258

382


QUARTER 4 – October 1st to December 31st, 2009

TOPIC

Tintinalli

5th EDITION

TINTINALLI

6th EDITION

ROsen

5TH eDITION

harwood-nuss 3RD EDITION

harwood-nuss 4th EDITION

Pulmonary/

Critical Care

443-496 (53)

141-148 (7)

219-251 (32)

437-486 (49)

1908-1911 (3)



155-161 (6)

938-1010 (72)



12-20 (8)

726-761 (35)



6-42(37)

198-243(46)



Cardiology

169-214 (45)

341-442 (102)



61-70 (9)

132-137 (5)

179-202 (23)

333-436 (103)



162-177 (15)

1011-1233 (222)



6-8 (2)

27-30 (3)

657-725 (68)


58-61(4)

246-303(58)



Anesthesia

79-101 (22)

251-280 (29)

1565-1570 (5)


102-123 (21)

257-286 (29)



2-27 (25)

2555-2590 (35)



1747-1761 (14)

1823-1841(19)

Obstetrics

680-713 (33)

94-98 (4)

664-690 (26)



2398-2484 (86)

314-378 (64)

494-533(40)

Gynecology

669-679 (10)

714-736 (22)



647-663 (16)

691-726 (35)



219-232 (13)

379-403 (24)

470-491(22)

TOTAL

321

362

474

218

226


ALL QUARTERS – Material fair game for any of the in-service exams

TOPIC

Tintinalli

5th EDITION

TINTINALLI

6th EDITION

ROsen

5TH eDITION

ROsen

6TH eDITION

harwood-nuss 3RD EDITION

harwood-nuss 4th EDITION

Toxicology

1057-1226 (169)

1015-1174 (59)

2063-2217 (154)

2325-2480


1392-1635 (243)

1436-1718(283)

Medicolegal













1719-1739 (20)

1812-1822(11)

Admin







2650-2657 (7)

2673-2697 (24)

2705-2724 (19)





1702-1707 (5)

1713-1718 (5)



1798-1802(5)

Research







2658-2672 (14)










Resuscitation

39-78 (39)

118-127 (29)

215-238 (23)

239-241 (3)

247-250 (3)





33-47 (14)

52-81 (29)

107-114 (7)





648-656 (8)

6-55(50)

Ultrasound

737-748 (11)










637-647 (10)

index p1907

TOTAL

277

59

268




291

349

18 MONTH TOTAL

1,666

1,512

2,275




1,723

1,912

Haydel July 2008

Revision 8/21/07


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