Grand Rounds Recap 11.8.17

Grand Rounds Recap 11.8.17

This week, we started things off with a great Quarterly Sim led by our faculty. The oral boards cases, led by Drs Stettler and Roche, involved an acute presentation of holiday heart, a post-partum patient with flash pulmonary edema, and a very questionable spider bite. The simulation, led by Drs Fernandez, Hill and Stolz, focused on two patients that were in shock: one due to a ruptured ectopic pregnancy and one due to a pericardial tamponade. We then moved on to the pediatric side of things, where Dr. Gleimer discussed neonatal rashes, and we took a look at pediatric syncope with Dr. Fananapazir. 

Read More

Grand Rounds 10.25.17

Grand Rounds 10.25.17

Dr. Ludmer kicked things off with this month's Morbidity & Mortality conference where we discussed C. Diff, spinal cord compression, LP in the setting of anticoagulation and cardiac arrest with an LVAD. Dr. Stettler led the next segment of our longitudinal leadership curriculum with a look at the mentor/mentee relationship. We finished up with a soapbox lecture by Dr. Titone on conflict resolution and an R3 follow up by Dr. Bernardoni who discussed the crashing patient with right ventricular failure and pulmonary arterial hypertension. 

Read More

Global Health: Reemerging Infectious Diseases

Global Health: Reemerging Infectious Diseases

Global is local. It is important as health care providers that we think about infectious diseases in terms of a global context. Reemerging infectious diseases represent a constant moving target for physicians and scientists. Understanding some of the factors behind disease reemergence as well as examples of current reemerging infectious diseases helps to illustrate how local changes can have a global effect. 

Read More

Just the thing for the faint of heart!

Just the thing for the faint of heart!

As Emergency Physicians, we pride ourselves on taking care of critically ill, undifferentiated patients. As technology as advanced, we’ve been able to add more and more tools to our arsenal to help guide the management of these patients. One such tool is cardiac ultrasonography. It is able to give us dynamic information about the patient, rule out life threatening pathology such as tamponade, and even help guide resuscitation in cardiac arrest. All of this, however hinges on the physician having the knowledge and skills to employ this in our fast paced environment. Are your skills up to snuff? Find out after the jump!

Read More

Grand Rounds Summary 10.18.17

Grand Rounds Summary 10.18.17

This week Dr. Gottula gave us a great in-depth explanation into alloimmunization and the use of RhoGAM in the ED. Dr. Owens and Faryar participated in a CPC centered around a sickle cell patient with knee pain. Dr. Asghar from orthopedics discussed the management of spine fractures in the ED. Our visiting professor Dr. Gail D'Onofrio discussed the ongoing opioid abuse issues facing the country. Dr. Hall discussed industrial injuries while Dr. Polsinelli wrapped things up with a discussion about how to use EMR to report core measures. 

Read More

Rh-D Alloimmunization Prevention in the Emergency Department

Rh-D Alloimmunization Prevention in the Emergency Department

The risk of alloimmunization in pregnancy is one the EP faces every day, but what are we preventing? when do we need to consider increasing our RhoGAM dosing? and do you really need a type and screen for the same patient in the same pregnancy? Dr. Gottula gets to the bottom of the type and screen and presents a rational algorithm for working up the Rh status of the pregnant patient in the ED.

Read More

Grand Rounds Summary 10.11.17

Grand Rounds Summary 10.11.17

Dr. Stolz started Grand Rounds off with a great talk on lung ultrasound. Our consultant of the month, Dr. Hebbeler-Clark, gave a talk on patient safety and swarms. Dr. Lipshaw, a Peds-EM fellow, discussed the differential, evaluation, and management of congenital heart disease babies in the Emergency Department. Finally, Dr. Teuber ended with an interesting discussion on priapism. 

Read More

Grand Rounds Summary 10.4.17

Grand Rounds Summary 10.4.17

This week Drs. Jarrell and Nagel kicked off Grand Rounds with their evidence based review of the hypertension management in the ED. Drs. Gorder, Lagasse, O'Brien, and Polsinelli discussed the difficult management of the patient in both cardiogenic and septic shock, reviewed heart murmurs, and endocarditis. Dr. Bryant made us squirm with her Global Health quick hit case review of parasitology, Dr. Lane led a great group discussion about the utility of procalcitonin in adults, and Drs. Habib and Roche ended Grand Rounds with a great CPC case!

Read More

Pro's and Con's of Procalcitonin

Pro's and Con's of Procalcitonin

Procalcitonin was reviewed on Taming the SRU in the context of other biomarkers (ESR, CRP) last year with a grand rounds discussion of its utility in the setting of a febrile 7 week old. As procalcitonin has continued to gain traction in the world of pediatric EM – receiving evaluation as part of proposed protocols for management of febrile infants (1) and for its utility as an aid to diagnosis of Serious Bacterial Infection (2,3) – we turned our attention this year to procalcitonin’s use in adults. Procalcitonin testing has been studied and available for decades (as St. Emlyn’s noted in an update earlier this year), but has not really established itself in widespread use in adults (as EMDocs noted in a sepsis update in 2014). In this blog post, we take the approach of going back to what is known (and is NOT known) about the biochemical basics of this molecule to give context to the sometimes confusing smorgasbord of proposed applications for procalcitonin testing that exists in the literature.

Read More

Grand Rounds Summary 9.27.17

Grand Rounds Summary 9.27.17

Dr. Titone held a great in-depth M&M this month with cases from tuberculosis to typhilitis (which is a thing). Drs. Baez and Goel took us through cases of coding Torsades and coding Pine Sol ingestions, followed by Dr. Skrobut who delicately closed the day with a discussion of testicular complaints in the ED.

Read More

Grand Rounds Summary 9.20.17

Grand Rounds Summary 9.20.17

This week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls.  This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate.  Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula.  Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine.  Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.

Read More

Annals of B Pod - Fall 2017 Issue Release!

Annals of B Pod - Fall 2017 Issue Release!

In the Fall 2017 edition of Annals of B Pod, our focus is on ocular emergencies. Dr. Murphy-Crews starts off with a case of acute angle closure glaucoma. This is followed by a detailed discussion of infectious keratitis and a procedure piece focusing on ocular ultrasound. Dr. Jarrell details a case of a traumatic
lens dislocation
. In addition to these ophthalmologic-focused articles, Dr. Habib expertly discusses placenta previa and important management techniques of patients with abnormal placentation. The recurring pharmacology article details medication safety in pregnancy. Finally, Dr. Scanlon's EKG Focus discusses the evaluation and management of wide complex tachycardias.

Read More