Thursday, February 18, 2021

SBO: Seize Back Onus – Focus on POCUS.

Image credit: Pexels
Ahmed Mamdouh Taha Mostafa, MD; Kevin C. Welch, DO; and Max Cooper, MD RDMS
Originally published: Common Sense
January/February 2021

A 76-year-old female with a past medical history of hypertension, obstructive sleep apnea, diverticulitis, fibromyalgia, osteoarthritis, depression, and renal cell carcinoma status post remote nephrectomy who presented to our ED with four days of intermittent, diffuse, crampy abdominal pain associated with nausea and non-bloody, non-bilious emesis, hiccoughs, and inability to tolerate PO.

On examination, vital signs were temperature of 98.3º F, pulse of 108 bpm, respiratory rate of 15, blood pressure 146/91 and oxygen saturation of 97% on room air. Significant findings on examination were mild, diffuse tenderness over the abdomen on palpation, which was soft, positive for bowel sounds on auscultation. Bedside ultrasound performed showed keyboard sign - plicae circularis on the interior aspect of the jejunal wall, “to-and-fro” motion, and dilated bowel loops raising suspicion for small bowel obstruction (SBO), which was confirmed by CT.

Thursday, February 4, 2021

How to Be a Great Senior Resident

Image credit: Pexels
Alexandria Gregory, MD – AAEM/RSA Editor, Common Sense
Originally published: Common Sense
January/February 2021

Four months after the beginning of second year, I still feel weird being called a “senior resident.” It feels like just yesterday I was the intern, lowest on the totem pole, learning to navigate the flow of patient care and the ED. I didn’t expect July 1st to feel any different than the days prior when I walked into my shift, but I was wrong. Suddenly, it felt as if my attendings trusted me more, and now there were more junior doctors seeking my advice regularly. I am lucky to be at an institution that encourages independence and leadership early on, so even at the beginning of PGY-2, we are working senior shifts and running critical care pod shifts, helping to supervise interns and medical students while in those roles. Even in just a few months, I have learned a lot about what makes for a great senior resident and the qualities I hope to emulate. A great senior resident: