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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
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.
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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.
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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
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Topics are all on an 18-month cycle (6 quarters) and have been adjusted for the 2008-09 year; quarter 5 starts July 2008.
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Subjects are organized by quarter with the number of total pages in parenthesis—You can complete an entire text in an 18-month cycle.
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Note the bottom of these tables is a list of topics that are fair game for every quarterly exam.
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All three major ER texts are represented by edition (Tintinalli, Rosen, and Harwood-Nuss). The new Adams text will be added ASAP.
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This list will also be posted to the LSUEM yahoo group.
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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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