Grand Rounds Recap 1.16.19

Grand Rounds Recap 1.16.19

Welcome to another Grand Rounds Recap. This week Dr. Sayal, a visiting lecturer from North York General Hospital in Toronto, Canada, started us off with some pearls and pitfalls for the patient presenting with musculoskeletal complaints. Next up was Dr. Thompson who provided us some tips on how to prevent the most common patient and consultant complaints in the emergency department. Dr. Habib then led us through an interesting case involving an internal degloving injury. We then ended the day with small groups and a simulation led by Drs. Baez, Shaw, and Summers involving emergency obstetrical presentations. Be sure to check out the video of Dr. Isaac Shaw’s peri-mortem c-section simulation. See you next week.

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The Head and the Heart: Hemodynamic Derangement in Isolated TBI

The Head and the Heart: Hemodynamic Derangement in Isolated TBI

We know that alterations in hemodynamics do not only occur in hemorrhagic shock.  Both obstructive (such as from tension pneumothorax) and neurogenic shock (for example, from a spinal cord transection), can result in hemodynamic compromise that would not be corrected by blood product administration.  There have been some studies that have shown isolated traumatic brain injury (TBI) can also cause hemodynamic derangements. This article looks at a paper which attempts to examine the incidence of cardiovascular instability in patients with TBI.

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Grand Rounds Recap 1.9.19

Grand Rounds Recap 1.9.19

We are excited to share our latest installment of the Grand Rounds Recap with you! Dr. Stettler opened the day with a discussion on leadership styles and how they affect our practice in the emergency department. Next up was Dr. Sabedra with a riveting case of new onset heart failure and acute ischemic stroke in a patient in his twenties. Dr. Berger then gave us a shot to the gut, in a good way, with a lecture on colitis. We then delved into the world of pediatrics with a lecture by Dr. Gray who helps us standardize our approach to evaluating for the possibility of child abuse. Dr. Hughes and Dr. Gottula then ended the day with a practice changing summary of the current literature and a new pathway for the management of NSTEMI.

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Annals of B-Pod: Human Trafficking

Annals of B-Pod: Human Trafficking

Though we may not realize it, human trafficking continues to consume the lives of young women and men throughout the world, including the United States. In this excellent piece, Dr. Jarrell details a presentation of a victim of trafficking to the emergency department and discusses various historical and physical exam findings that should raise a provider’s concern for possible human trafficking.

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Grand Rounds Recap 1.2.19

Grand Rounds Recap 1.2.19

We had an excellent series of lectures this week at our Grand Rounds to welcome in the New Year! The esteemed Drs. Calhoun and Stettler started us off with our Great Debate series pitting Ketofol against Ketamine or Propofol alone for procedural sedation. The winner of this debate? Definitely the audience who got to soak up the expertise from these clinical giants. Next up was Dr. Leenellett who guided us through some community ED cases of early pregnancy vaginal bleeding in our Discharge, Transfer, or Treat lecture series. Dr. Laurence then led us through a small group case based discussion on the indications for massive transfusions in trauma. Then a hush fell over the crowd as Dr. Iparraguierre laid down the CPC gauntlet with a presentation of Myasthenia Gravis for Dr. LaFollete who masterfully identified the Ice Pack Test as the diagnostic test of choice! Next up was Dr. Colmer who gave some tips for the management of severe alcohol withdrawal with his case follow-up lecture. There was no knocking this knowledge train off the tracks as Dr. Urbanowicz led us through a harrowing discussion on Weapons of Mass Destruction. To round out the day Drs. Klaszky, Gauger, and Murphy Crews led us through some small group exercises on the NIH stroke scale, CT angiography of the head and neck interpretation, neurological emergencies jeopardy, and indications for performing a burr hole with some hands on practice (simulation of course!).

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Massive Transfusion Triggers: Back to the ABCs (score)

Massive Transfusion Triggers: Back to the ABCs (score)

Massive Transfusion (MT) is a life-saving trigger in trauma centers, but heavy is the burden of activating significant resources without knowing the blood products will go to good use. The ABC is the ACS recommendation, is easy and requires no additional testing, however newer weighted scores like PWH and TASH have showed promise in external validations. This week, Dr. Laurence takes a deep dive into the literature behind these triggers, their validation as well as some take aways for your use of life-saving Massive Transfusion.

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Grand Rounds Recap 12.19.18

Grand Rounds Recap 12.19.18

Come check-out our Grand Rounds Summary for 12.19.18! We started the morning with some fascinating cases in Morbidity and Mortality Conference with Dr. Baez. Next, we learned the importance and efficacy of mindfulness with Dr. Bernardoni. Dr. Makinen and Dr. Curry went head-to-head on a Clinical Pathologic Conference about a patient with hyperthermia due to sympathomimetic overdose. Lastly, Dr. Frederick taught us the evidence behind PECARN!

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To Scan or Not to Scan? PECARN for Pediatric Head Trauma.

To Scan or Not to Scan? PECARN for Pediatric Head Trauma.

When a child comes in to the emergency department for head trauma, it can be difficult to balance unwanted, and possibly unnecessary radiation, with the risk of missing clinically significant head trauma. CT scans of the head allow providers to rapidly identify, and subsequently address dangerous and potentially life-threatening intracranial trauma and hemorrhages. However, as with everything in medicine, a CT scan is not without risks, particularly in the pediatric patient. With over 500,000 ED visits per year dedicated to pediatric head traumas, this is a challenge that emergency medicine providers face frequently (1).  A study published in 2001 suggests that approximately 170 deaths were attributable to one year of CT head examinations in pediatric patients (2), and utilization of CT imaging has only increased since. Therefore, as with any radiation based imaging, careful consideration should be given to whether the test is truly necessary. As mechanism of injury and post-trauma symptoms can range drastically, it can be difficult to accurately assess the appropriateness of imaging in a child. As such, the pediatric emergency care applied research network (PECARN) worked to develop a clinical decision tool to guide clinicians in the need for head CT following pediatric head trauma.

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Grand Rounds Recap 12/12/18

Grand Rounds Recap 12/12/18

This was an exciting week of Grand Rounds discussions on a variety of topics. We began with a discussion of prehospital sepsis care and an update on EMS protocols in Southwest Ohio. The combined EM-Neuro conference provided a lively discussion on Guillain-Barre syndrome. The quarterly operations update was followed by a detailed discussion on esophagitis management in the ED. Finally, the pediatric fellows led a series of case discussions on a variety of devastating pediatric illness.

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Catheter Associated Urinary Tract Infections and Foley Alternatives

Catheter Associated Urinary Tract Infections and Foley Alternatives

Catheter associated urinary tract infection (“CAUTI”) is one of the most common nosocomial infections in hospitalized patients. The use of external urinary catheters, the male external catheter, colloquially known as the “condom catheter,” and the wicking catheter, most often used in females, may help prevent the occurrence of CAUTI. In the Emergency Department, we are poised in a position where what we do (or don't do, such as insert a foley) has the potential to reduce iatrogenic harm throughout the hospital.

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Grand Rounds Recap 12.5.2018

Grand Rounds Recap 12.5.2018

We had another excellent Grand Rounds this week! Dr. Carleton started us off with some thrilling airway cases in his continuing Airway Grand Rounds series. Next, we were transported to Africa for a case based discussion on Global Health with Drs Owens, Sabedra, Ventura, and Murphy-Crews. Dr. Skrobut and Chris Shaw then took us through a deep dive of the current literature on the management of upper GI bleeds. Dr. Ham then taught us about ACE-I induced angioedema through the lens of an amazing case of a patient who required a cricothyrotomy to save her life! Next up, we had Dr. Gleimer go up against Dr. Faryar in our Clincal Pathological Case series where we a classic presentation of Addison’s disease in a pediatric patient. Dr. Hunt then led us through small group discussions on the application of the HEART Score in patients presenting to the ED with chest pain. We wrapped up the day with Dr. Isaac Shaw who presented a the management of SVT in a complicated patient.

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Diagnostic Questions of the HEART

Diagnostic Questions of the HEART

Chest pain is a part of our everyday practice, as has become utilization of the HEART score. Successfully weathering a storm of validation, it is incumbent upon us to know the data and variability to its use in the ED. This week Dr. Hunt will take us through the diagnostic view on the HEART score and the data behind it.

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Grand Rounds Recap 11.28.18

Grand Rounds Recap 11.28.18

Check out this week’s recap of Grand Rounds! Dr. Tim Murphy took us through some fascinating cases with Morbidity and Mortality Conference. Next, we got to dive deep into toxicology. Dr. Kelli Jarrell led us through a case she had of a TCA overdose, Dr. Shawn Hassani taught us about Beta Blocker and Calcium Channel Blocker overdose, and Dr. Woods Curry took us through a oral boards session during Quarterly Sim reviewing Aspirin toxicity. Quarterly Simulation also had an oral boards case discussing inferior STEMI complicated by complete heart block, as well as an awesome simulation teaching the fundamentals of teamwork and closed loop communication by having a lucky R3 run a code with a blindfold on. We’re excited to share the learning highlights with you!

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Annals of B-Pod: Hereditary Angioedema

Annals of B-Pod: Hereditary Angioedema

There are not many universal, unequivocal truths in medicine, but we can mostly agree that breathing is pretty important. It follows that diseases, injuries, or illnesses that interfere with our airways are problematic. Hereditary angioedema is a uniquely terrifying pathology in which the body’s inflammatory system is aberrantly activated, leading to swelling and collapse of a patient’s larynx. In this case, Dr. Shaw walks us through a presentation and management of a patient with hereditary angioedema in the emergency department.

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