Schrag’s Community Pearls

Post Tonsillectomy

  • Most common is pain and decreased PO
    • Opioids, anti emetic IVF gets most people through
    • Need to Call ENT before adding on NSAIDs or steroids
  • Post-tonsillectomy Bleed
    • Early bleed (w/in 24 hrs) is the scary one
      • 1st step is to call ENT to come in
      • Direct pressure only real control option
      • Try not to intubate
    • Late bleed
      • When eschar falls off
      • Typically less severe/scary
      • Still call ENT in and they will take care of it

Cosmetic Surgery Complications

  • Call the surgeon who performed the surgery – for anything cosmetic the surgeons want to know (these are customers not patients)
  • Breast Augmentation Early complications
    • Unwrap the dressing
    • Hematoma/Seroma and infection most common early complications
    • Don’t attempt any drainage or procedure
    • Get a good exam and talk to the surgeon
  • Liposuction
    • Hypovolemia related syncope/near-syncope
      • Most common complication
    • Lidocaine toxicity
    • Pneumothorax
  • Fat Injection
    • Difficult to differentiate infection vs inflammation

Plastic Surgeon Demands

  • Where and what type of laceration
  • What is your audience
  • Were they transferred for plastics? Don’t promise if transferring.
  • Can call plastics – start conversation with “I do not expect you to come in but I told the parents I would talk to you about this…”
  • Can frame as primary closure now, could see plastics later for revision

Fertility Patients

  • Usually on high estrogen
  • PE/DVT are high risk
  • Ovarian torsion – larger ovary = high risk
  • Heterotopic pregnancy
  • Miscarriage is an even higher emotional stakes event

Bladder Irrigation

  • Need to know how to do this
  • Don’t call urology to come in to do this

Psych

  • Try to see before SW/crisis and form your own opinion
  • Collateral helpful
  • Patients not reliable
  • VERY RISKY
  • Go with the most conservative approach

Organizing a Transfer

  • Talk to pt about it – you can suggest but ultimate decision on destination is theirs
  • Start with the reason for the transfer when you call e.g.. SDH needs neurosurgery
  • VS – Have them in front of you when you make the call
  • Send along labs, imaging, paperwork, your note – have to know the logistics for this and consider sending the disc just in case

MRI/MRCP

  • TIA
  • Vertigo
  • 1st time seizure
  • MRCP for elevated LFT and lipase, concern for CBD stone

Intoxicated Patients

  • Look for detox bed or sober friend
  • If any airway issues, intubate and admit – direct obs and EtCO2 not an option d/t resource constraints in the community
  • Restraints?
  • Sedation?