NSAIDs in a Patient with Fractures?!

NSAIDs in a Patient with Fractures?!

The Issue

NSAIDs are excellent analgesics that can decrease the use of opiatess for pain, but might lead to poor healing from orthopedic injuries.

Prior Evidence

In vitro studies and rat models since the early 80s showed delayed fracture healing with NSAIDs, and the effects appeared to be dose-related. These findings have been re-demonstrated in future in vitro and rat studies as well.   In humans however, the data has been, to say the least, mixed...

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Grand Rounds Recap 8.17.2016

Grand Rounds Recap 8.17.2016

This week included our first every chalk-talk about antibiotics focusing on beta-lactams. We had our quarterly AirCare grand rounds where we learned about some special tools we carry on the aircraft including point of care lab testing and specialized suction devices. We also did a high fidelity hemorrhagic shock simulation. In two case follow-ups we learned about some special considerations in ACS and for pregnant patients in trauma. Read on!

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A Healthy Dose of Fallibilism

A Healthy Dose of Fallibilism
“Reason itself is fallible, and this fallibility must find a place in our logic.” - Nicola Abbagnano

Decision making in Emergency Medicine is intensely complex and it also the defining characteristic of the practice of Emergency Medicine.  To outside eyes we may seem to be a specialty of action: chest tubes, intubations, heroic resuscitations with massive amounts of blood products and IV infusions.  In truth none of the “action” of our specialty, the big sexy things they make into TV shows and movies, occurs without rapid, precise, and accurate thinking and decision making.  But the Emergency Department can be a hostile environment to the decision making process.   And, I’m not just talking about the noisy environment, the multiple interruptions, the patients with a wide variety of chief complaints and acuity seen in quick succession.  There’s seemingly a thousand different hurdles between the instant a patient recognizes that something might be wrong with them and the moment a clinician diagnoses the problem. 

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Grand Rounds Recap 8/10

Grand Rounds Recap 8/10

This week, Dr. Palmer updated us on operations within the department, and dropped some stroke knowledge with his case follow up of altered mental status in a sickle cell patient. Drs. Scupp and Merriam presented cases on pediatric headache and hypothermia, respectively. Dr. Fananapazir tackled etiologies of fever including UTI and Kawasaki in our combined EM/PEDS lecture. We were honored to receive guest speaker Dr. Catherine Marco from Wright State University, who is senior member of the executive committee of ABEM and lectured on ethical issues of resuscitation.

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Protect Me! "Flights" #4 Recap

Protect Me! "Flights" #4 Recap

Welcome to the Final Recap of our “Flights” Case Series!

Thanks to all those who participated in the discussion and to those who tuned into the “Flights” cases throughout the spring and summer.  The final "Flights" cases centered in on several challenging airway scenarios.  Penetrating neck trauma with a tracheal injury; GSW to the face with significantly altered anatomy; and a tracheostomy displaced and a patient with critical hypoxia - airway management in the field requires a nimble mind and knowledge of one's own equipment.  Take a look at our thoughts on the cases and see what you might do in similar situations.

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Grand Rounds Recap 7/27/2016

Grand Rounds Recap 7/27/2016

This week in Grand Rounds we reviewed the morbidity and mortality cases from June and learned about infective endocarditis, intimate partner violence, tracheal injuries, pituitary adenomas, hepatic encephalopathy, epistaxis, and carfentanil - a new and dangerous adulterant in heroin. Dr. Denney was challenged to a case of dural venous sinus thrombosis. We learned about the life of an Air Force Reserve physician with Dr. Powell. Dr. Derks taught us about negative pressure pulmonary edema. Finally, we asked the question #whatsyourquestion? and reviewed how to call a good consult. Read on!

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Eating for Shift Work

Eating for Shift Work

It’s August, 90s greats are hitting the Cincinnati music scene, the Olympics are starting (August 5th), and we are all beginning to settle into our new roles. The beginning of a new year with new responsibilities can be exciting, terrifying, and exhausting, often all at the same time. It can be hard to make time to take care of yourself, especially on shift. Basic ADLs like using the bathroom and eating often go by the wayside. This month, we want to focus on tips for eating on shift.

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Grand Rounds Recap - 7/20/2016

Grand Rounds Recap - 7/20/2016

This week Dr. Knight taught us about the management of seizures and about how to manage our own fear. We were schooled on the hypotensive LVAD patient by Drs. Boyer, DeVries and Winders. We learned about oncologic emergencies from Dr. Continenza. Dr. Gorder tamed the SRU and taught us about chemical asphyxiation and burn injuries in the process.

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Grand Rounds Recap 7/6/2016

Grand Rounds Recap 7/6/2016

This week we got an operations update with some new markers of quality and new guidelines on HIV testing. We were reminded about patient literacy and the advantages of keeping it simple. Dr. Hill also taught that every shift our biases and decision making do affect patient care, it is our duty to recognize and use them to our patients' advantage.

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Grand Rounds Recap - 6/29/2016

Grand Rounds Recap - 6/29/2016

Professionalism is a belief system.

Management of the Red Eye in a Community ED.

Case #1: 28 yo M who was poked in the eye while wrestling. Small periorbital ecchymosis, conjunctival erythema, reactive pupils, consensual photophobia, fluorescein negative. Normal IOP bilaterally.

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Grand Rounds Recap 6/22

Grand Rounds Recap 6/22

MORBIDITY AND MORTALITY CONFERENCE WITH DR. DENNEY

Stroke Chameleons

  • Stroke chameleons are atypical presentations of stroke and are associated with delays in diagnoses and failure to administer intervention when otherwise indicated
  • Maintaining a diagnosis of stroke on the differential is paramount to being able to diagnose a chameleon. Characteristics of chameleons that we most frequently miss are:
    • Atypical presentations (we miss 4% of typical vs 64% of atypical) 
    • Strokes in the young
    • Cerebellar strokes
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A Walk in the Woods

A Walk in the Woods

“Go outside!” These words rang through my childhood. My brother and I were explorers of every creek and cave on our wooded mountain property. We were allowed in for a quick lunch and bathroom breaks only. I find myself doing the same thing with my kids now. We all intuitively know that being outside is good for us. For those that believe nothing unless it is randomized and proven in a dose-response relationship, there are multiple studies and meta-analyses proving this.1,2,3 Additionally, we are all health professionals; we know that exercise is good for the body. So, this article serves as a simple reminder now that summer has arrived.

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Grand Rounds Recap - 6/15/16

Grand Rounds Recap - 6/15/16

This week the airway guru Dr. Steve Carleton outlines trends in airway management and makes a compelling case for keeping blind nasotracheal intubation in the toolkit of your aircraft. Dr. Plash gives us a difficult case of LVAD complications. Dr. Lagasse discusses acute aortic complications and Drs. Thompson and Gorder discuss their protocol for post-ROSC care.

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