What's in a Blood Gas? VBG vs ABG

What's in a Blood Gas? VBG vs ABG

You’re deep into a busy shift. Pushing yourself to see more volume towards the end of the year, you find yourself actively managing 8 patients.  You have 2 patients with difficulty breathing you believe have COPD exacerbations and 1 patient with a history of T1DM who has a critical high finger stick blood sugar and ketones in their urine.  You send VBGs as part of the work up for all these patients finding hypercarbia for the patients who have COPD exacerbations and a significant metabolic acidosis in the patient with T1DM confirming your diagnosis of DKA. You are in the process of admitting these patients when you face questions from your colleagues in-house as to why you didn’t perform an ABG on these patients?

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Grand Rounds Recap 5.9.18

Grand Rounds Recap 5.9.18

This week Drs. Harty & Gauger walked us through the literature surrounding the care of the patient in cardiac arrest as part of their Quality Improvement & Knowledge Translation project. Dr. Kristiana Kaufmann, a visiting professor from Wayne State, provided us a look at Global Health opportunities. Our Quarterly Simulation session, lead by Dr. Bryant, was a case of a 15 year old with new onset SOB and polyarthralgias. Lastly Drs. Stettler & LaFollette provided us with mock oral boards cases.

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Air Care Orientation Case #3

Air Care Orientation Case #3

April brought the third case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of STEMI, seemingly simple, right… but what happens next?

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Grand Rounds Recap 4.25.18

Grand Rounds Recap 4.25.18

This week’s Grand Rounds was kicked off with our W. Brian Gibler visiting professor series with Dr. Ali Raja M.D., MBA, MPH, and Vice Chair of Emergency Medicine at Massachusetts General Hospital. He gave us his insights on how to help move our specialty towards evidence based practice, as well as his tips on leadership within the context of academic emergency medicine. This was followed by our monthly Morbidity and Mortality Conference with Dr. Titone. Dr. Shah then gave his R4 Clinical Soap Box on the utility of ultrasound in cardiac arrest, and the conference finished with Dr. Whitford giving his R3 Taming the SRU case follow up.

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Rhogam Redux

Rhogam Redux

Hemolytic Disease of the Fetus and Newborn (HDFN) is an alloimmune disease which develops in a fetus when a women’s immune system is sensitized, developing antibodies which cross the placenta and attack fetal RBCs. 

While there is a spectrum of the disease, in severe cases the fetus can ultimately develop hydrops fetalis which is often fatal.

As Emergency Physician’s we are classically taught that we can help to prevent HDFN by recognizing sensitizing events in Rh-negative women and subsequently providing RhoGAM. But which patients really need RhoGAM? The evidence seems to be lacking and recommendations are often inconsistent.

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Grand Rounds Recap 4.18.18

Grand Rounds Recap 4.18.18

This week we got a refreshing look at soft tissue ultrasound from our US guru Dr. Stolz. We then moved to the opposite end of modern imaging with the rarely indicated but intermittently very useful KUB by Dr. Skrobut. Drs Kiser and Ventura battled it out in a CPC case of pyloric stenosis then the R4s ran a simulation and small group on global health pathologies.

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AirCare Series: Resuscitative Hysterotomy

AirCare Series: Resuscitative Hysterotomy

Air Care Series is back!  This time with one of the most feared procedures in pre-hospital medicine: the Resuscitative Hysterotomy (aka peri-mortem c-section).  Pregnant patients scare us, but coding pregnant patients scare us even more.  Read on to learn not only when to perform this procedure, but how to perform it properly and safely.  

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Annals of B-Pod - The Spring Issue is Sprung!

Annals of B-Pod - The Spring Issue is Sprung!

And lo, as the gellid depths of winter give way to the fairer climes of spring, another issue of the Annals must too follow. The spring issue focuses primarily on perplexing neurological maladies that plague our patients, including a case series on meningitis as well as Dr. Makinen's phenomenal write-up of a fascinating presentation of Creutzfeldt-Jakob disease. Also be on the look-out for an excellent review of anticoagulant reversal agents and my own piece on a caustic laundry pod ingestion. So take a moment to stop and smell the roses as we welcome another edition of #AoBP!

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Annals of B-Pod: Creutzfeldt-Jakob Disease

Annals of B-Pod: Creutzfeldt-Jakob Disease

What's in a name? That which we call Creutzfeldt-Jakob disease by any other name would be as devastating. And how, do neurologists ever love their names! CJD - also known as "spongiform encephalopathy" and the comically grim "mad cow disease" - is an uncommon but uniformly fatal form of rapidly progressive dementia. In this case, Dr. Makinen takes us through the presenting features, definite diagnosis, and emergent management of the prion-mediated encephalopathy we call CJD. An entity which would, were it not CJD call'd, retain its dear morbidity.

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