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ISBAR - PowerPoint PPT Presentation


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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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Presentation Transcript
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.
slide2

There does not seem to be any lectures or resources relating to this.

  • EBM
  • Decisions trees, algorithms.
  • Lots of holes.
  • Has anyone actually seen EBM in action in the hospital?
  • How many people in this course are really capable of using statistics….
slide3
ECG
  • One particular program in correctly picking up MIs from an ECG
    • Cardiologists – 680/820 correct
    • Computer – 738/820 correct
slide4

Apparently previous years exam question…

  • New introduced robot doctor, what can’t it do?
true story from a book
True story… from a book…
  • 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.
slide7

Red, swollen leg, 23 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?
slide8

You get her story.

  • 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.
slide9

You remember that three weeks ago you had another patient with what was thought to be cellulitis, but he didn’t get better.

  • He went into shock, and eventually died.
  • Necrotising fasciitis.
slide10

In the US about

    • 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?
slide11

Realistically, the biopsy shouldn’t happen, the chances of it being necrotising fasciitis are just way too low.

  • Something in your gut tells you that you should biopsy.