Grand Rounds - Dr. Brit Long - Choose your own adventure - High risk diseases in the emergency department
Feb 14, 2025
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Dr. Brit Long, an engaging Emergency Medicine physician and Lieutenant Colonel in the US Air Force, delivers an interactive talk on high-risk, low-frequency conditions in the emergency department. He discusses complex cases like spinal epidural abscess and cervical artery dissection, stressing timely interventions. The episode dives into managing ectopic pregnancies and revealing insights on toxic shock syndrome, all while sharing personal anecdotes and emphasizing the role of education and collaboration in military medicine.
Dr. Brit Long emphasizes the importance of interactive learning in emergency medicine by engaging listeners in case discussions of high-risk diseases.
The podcast details the challenges in diagnosing spinal epidural abscess, highlighting key risk factors and the necessity for timely imaging and intervention.
Critical conditions like decompensated hypothyroidism and cerebral venous thrombosis require swift diagnostic measures and specific treatment approaches to prevent severe complications.
Deep dives
Engaging Educational Experience
The podcast provides an interactive format for learning about high-risk diseases faced in emergency medicine, effectively engaging the audience through case discussions. Dr. Britt Long leads this session with a focus on uncommon but critical conditions that require careful diagnostic and management approaches. He emphasizes the importance of participation, encouraging listeners to select cases they want to discuss, which fosters a hands-on learning environment. By utilizing real patient scenarios, the episode illustrates the complexities and nuances of emergency patient care.
Spinal Epidural Abscess Diagnosis
The discussion on spinal epidural abscess highlights its challenging diagnosis due to atypical presentations often mistaken for common back pain or flu-like symptoms. Dr. Long outlines key risk factors such as recent vascular access, end-stage renal disease, and diabetes, which should alert healthcare providers to consider this serious condition. The clinical approach includes identifying red flags and utilizing MRI imaging to confirm the diagnosis before permanent deficits occur. Emphasizing the need for prompt intervention, he notes that both antibiotics and surgical consultation are critical for optimal patient management.
Decompensated Hypothyroidism Insights
Decompensated hypothyroidism in older patients, characterized by alterations in mental status, bradycardia, and hypotension, is another critical topic addressed in the podcast. The condition often arises from triggers like infections or medication non-adherence, leading to severe complications and a high mortality rate if not recognized and treated promptly. Dr. Long stresses that timely laboratory evaluations, including TSH and T4 levels, are important for establishing a diagnosis. Treatment involves addressing the underlying cause, providing appropriate thyroid hormone replacement, and managing potential complications with supportive care.
Cerebral Venous Thrombosis Awareness
Cerebral venous thrombosis (CVT) is explored as a rare but significant condition, particularly affecting younger women and often misdiagnosed due to its similar presentation to other disorders. The podcast emphasizes the importance of recognizing unique symptoms such as gradually worsening headache and focal neurologic deficits. Diagnostic imaging like CT venography is crucial as standard head CTs may not reveal CVT, which can lead to delays in care. Dr. Long underlines the importance of anticoagulation therapy even in cases of intracerebral hemorrhage, highlighting its role in preventing long-term morbidity.
Recognition of Toxic Shock Syndrome
Toxic shock syndrome (TSS), primarily caused by staphylococcal or streptococcal infections, is discussed as a severe systemic illness with a high mortality rate. The podcast highlights the nonspecific nature of symptoms like fever, diffuse rash, and acute hypotension, which can lead to misdiagnosis if clinicians are not vigilant. Dr. Long advocates for early recognition and treatment, including prompt administration of broad-spectrum antibiotics and aggressive fluid resuscitation. He emphasizes the critical nature of source control and rapid management to improve patient outcomes in cases of suspected TSS.
Legendary emergency medicine educator, Dr. Brit Long, gave grand rounds in Rochester in a highly interactive experience covering high risk, yet low frequency conditions that we need to watch for on shift. He uses an engaging style filled with cases to drill home key points related to these conditions. Enjoy this Valentine's Day chapter of Always on EM-Grand Rounds for a fun and engaging reminder of what our specialty is all about!
