The Future of Airway Management?

The Future of Airway Management?

What is the future of airway management in the ED?  How can we make our practice more effective and more efficient?  In this journal club recap, we focus on 2 topics emerging in the literature - flush rate O2 for pre-oxygenation and head of bed elevation during intubation.

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

Since the turn of the century, lactate has become a mainstay in emergency medicine and critical care laboratories. Some clinicians may hate it, others may love it, but very few can feign apathy on the subject. The utility of lactate in the emergency department and the ICU in guiding resuscitations, predicting mortality, or identifying occult critical illness continues to be discussed in the literature, most fervently in the realm of sepsis. But what are the humble beginnings of this molecule? Most fundamentally, how is lactate generated in the setting of critical illness? And how did it come to be so firmly embedded in our understanding of the pathophysiology of critically ill patients?

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Grand Rounds Summary 9.13.17

Grand Rounds Summary 9.13.17

'Twas a fantastic grand rounds.  Drs. Banning and Golden started it off taking us through the most recent evidence for management of sub-massive and massive PE, as well as presenting their algorithm to be published on Emergency KT.  This was followed by a global health lecture given by Dr. Lagasse, which covered a range of re-emerging infectious diseases.  Next, Dr. Bryant took us through multiple pediatric cases, and discussed her approach in determining whether to discharge, transfer, or treat pediatric patients with common / representative complaints.  Dr. Adeoye then took us through the history and development of our current approach to the management of acute ischemic stroke.  Dr. LaFollette then took us through an evidence based approach to removing things from where they shouldn't be in his edition of mastering minor care, discussing approaches to removing retained objects from ears and skin.  We then finished the conference with two interesting cases:  One presented by Dr. Sabedra that was followed by a discussion on the diagnosis and management of massive hemoptysis, and the other presented by Dr. Dang illustrating the differences and similarities hyperthermic toxidromes including NMS and serotonin syndrome as well as their management.  

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Angle Closure Glaucoma

Angle Closure Glaucoma

For many emergency physicians, ophthalmologic complaints are seemingly shrouded in mystery and pose a distinct diagnostic and therapeutic challenge. What the heck is gonioscopy? Which eye does OU refer to again? Does latanoprost really change the color of your iris? In this case, we join Dr. Murphy-Crews as he parses the enigma of acute closure glaucoma, its pathophysiology, and the appropriate management in the emergency department.

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Placenta Previa

Placenta Previa

Delivering neonates in the emergency department can be a stressful process, in part due to the potential for serious maternal or infant morbidity. In this article, Dr. Habib will discuss a case of placenta previa and walk us through how to recognize placental pathology, its pathophysiology, and appropriate emergent management.

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Grand Rounds Summary 9.6.17

Grand Rounds Summary 9.6.17

Dr. McKinney from our MFM service started us off with some pearls of 2nd and 3rd trimester complications and management. Drs Murphy, Liebman, McKee and Whitford taught small groups about tips and tricks of extensor tendon repair, hip ultrasound and compartment pressures. Dr. Hughes gave us a talk on plain film utility in the ED and finally Drs. Scanlon and Doerning faced off in a CPC of a case of HELLP syndrome.

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Think FAST!

Think FAST!

The ultrasound machine has quickly become a fixture in the emergency department. For good reason, the machine often lives in the trauma or resuscitation bay, seemingly anxiously awaiting use. In recent years we have seen multiple protocols and algorithms for the use of ultrasound in differentiating trauma patients. There is no doubt that it can be a powerful tool in these patients, but one must be adept with its use and aware of potential pitfalls in order to use ultrasound effectively in these high pressure situations.

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Soft Tissue Neck Radiographs - Are They Useful?

Soft Tissue Neck Radiographs - Are They Useful?

In March 2015, Dr. Renne did a Grand Rounds lecture on soft tissue neck radiographs, which offers a great review of normal anatomy and systematic approach to reading films (“CHESS”). Yet, in my small, informal (not scientific at all) poll of some of our residents, none had ever ordered a soft tissue neck film. Are soft tissue neck radiographs useful? You be the judge. 

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Grand Rounds Recap 8.30.2017

Grand Rounds Recap 8.30.2017

This week Dr. Gorder led us off with August's M&M cases, followed by Dr. Betz giving us great in-depth example of a proper joint exam from the perspective of sports medicine. Dr. Makinen gave us a talk of accidental hypothermia, Dr. Ludmer examined the link between chronic pain and depression and how concurrent treatment can help our patients quality of life. Dr. Wright gave us an update on UCEM Global Health and Dr. Colmer gave us a look into the critical care management of a DKA case.

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Troublesome Tracheostomies

Troublesome Tracheostomies

Troubles with tracheostomy tubes can be some of the most anxiety provoking complaints we see in the Emergency Department.  Airway master and Dr. IC Cordes himself, Dr. Steven Carleton, MD PhD joined me on the podcast to help demystify 2 common tracheostomy related complaints - the bleeding trach site and the displaced tracheostomy tube.

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Grand Rounds Recap 8.23.17

Grand Rounds Recap 8.23.17

Dr. Carleton started things off with a review of oral fiberoptic intubation and a step by step guide to trach recanalization. Next we headed off to EM-Neuro combined conference where Dr. Neel discussed headaches that kill, headaches that maim and headaches that annoy. Dr. Thompson walked us through a case of vertebral artery dissection and Dr. Liebman kicked off our wellness curriculum. Dr. Roche finished things up with a discussion the nuances of toxicology in the community. 

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Not Just Sound... It's ULTRAsound!

Not Just Sound... It's ULTRAsound!

Over recent years, ultrasound has permeated our specialty and become a core component in how we provide patient care. It allows us to obtain real time information and make clinical decisions, all while avoiding the harms of more traditional imaging techniques.

But what exactly is going on behind the scenes here?  Take a look at our educational pages dedicated to ultrasound physics and knobology

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