Monday: Back to Basics - Food Impaction

Often plan films will not see food, CT scan is high yeild test to find esophageal FB

Recommend against use of proteolytic enzymes to dissolve meat

Glucagon 1-2mg IV to relax lower sphincter, although rarely works

Gass forming agents (carbonated beverages) have success rate up to 80%

Endoscopy via GI is definitive management. If greater than 12 hrs, call them up front.

Tuesday: Advanced Practice - Bariatric Surgery Complications

Internal Hernia - hernia stuck through new defect in mesentery - strangulation and necrosis

Bleeding - usually early post op along suture / stable line

Abastomotic leak - usually early but can be dealyed by days to weeks. Look for persistent tachycardia, CT not sensitive enough

PE - #2 cause of death in post bariatric patients

Even more listed in entire post

Wednesday: What's the Diagnosis?

Thursday: #emconf - Splinting Complications

Watch for heat injuries especially with large number of plaster layers

Pressure Sore - look for pressure points and add extra padding

Compartment syndrome - document a post splint neurovascular exam

Friday: Critical Care - Blunt Cardiac Injury

Step one = EKG, if new ST changes, ischemia or arrhythmias admit to tele for monitoring

Normal EKG and negative troponin make blunt cardiac injury extremely unlikley

Sternal fracture does not equal blunt cardiac injury

Saturady: Board Review - IV tPA

Do you know your reltive and absolute contraindications?

Test your knowledge!