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

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ISBAR

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  1. 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.

  2. 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….

  3. ECG • One particular program in correctly picking up MIs from an ECG • Cardiologists – 680/820 correct • Computer – 738/820 correct

  4. Apparently previous years exam question… • New introduced robot doctor, what can’t it do?

  5. 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.

  6. 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?

  7. 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.

  8. 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.

  9. 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?

  10. 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.

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