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ISBAR. I - Yo ENT surgeon, I’m Alex, a GP. S – I have a 34 year old male with a three week history of hoarse voice. Patient has right cervical and left axillary lymphadenopathy . B – He is usually well, no significant medical history, none smoker, and no medication.

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Isbar
ISBAR

  • I - Yo ENT surgeon, I’m Alex, a GP.

  • S – I have a 34 year old male with a three week history of hoarse voice. Patient has right cervical and left axillarylymphadenopathy.

  • B – He is usually well, no significant medical history, none smoker, and no medication.

  • A - Vocal cord paralysis seems possible.

  • R – Please examine.



ECG to this.

  • One particular program in correctly picking up MIs from an ECG

    • Cardiologists – 680/820 correct

    • Computer – 738/820 correct



True story from a book
True story… from a book… to this.

  • You are a senior surgical resident in the ED.

  • Just finished admitting someone with a gallbladder infection.

  • It is 2 pm, you have been in the ED since 9 pm the previous night.

  • An ER physician stops you on your way to finally get some food with a case.


  • Red, swollen leg, 23 to this.yo female.

  • The ER physician tells you that it is a bad case of cellulitis, already started on IV antibiotics.

  • The ER physician wanted to make sure there wasn’t anything surgical going on…

  • What do you want to ask her?


  • You get her story. to this.

  • Blister on big toes two days ago. Foot began getting painful, redness spread.

  • During the night had a fever and chills.

  • Saw her GP who got an X-ray to rule out involvement of the bone, gave her IV antibiotics, and antibiotic pills to take home.

  • The redness continued to spread. Went to hospital. No more fevers since that initial fever.

  • DDx. Go.



  • In the US about with what was thought to be

    • 1000 cases of necrotising fasciitis a year.

    • Over 3 million cases of cellulitis.

  • Necrotising fasciitis

    • Kills 70% of the people who have it.

    • Often requires amputation, next step would be biopsy.

  • How likely it is that this is necrotising fasciitis?



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