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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"Protect Me" - Flights Case 4

"Protect Me" - Flights Case 4

Welcome to the Fourth Case in our Air Care and Mobile Care Flight Orientation Curriculum for 2016! 

It is a beautiful sunny Memorial Day and you arrive early for your C-pod shift, energized by the knowledge that you will be getting out early with time to enjoy the day. Your patients are an enjoyable mix of pathology and acuity and everyone is quite polite and gracious. The tones drop just before it is time to hand over the radio to the dedicated flight doc and you can’t but marvel at your good fortune. You grab the blood and head up to the helipad for your flight...

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Clinical Approach to Knee Radiographs

Early in the morning, you begin your day in your local emergency department. After getting yourself situated, a slow trickle of patients begin to appear on the board. It appears to be a normal morning, all except for the fact that five patients appear, one after the other, who have the same chief complaint: “Knee pain”. It is a good thing you brushed up on reading knee x-rays recently!

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June Issue - Annals of B-Pod

June Issue - Annals of B-Pod

It’s that time in every Emergency Department: the academic year has come to a close. In our shop, interns are spending their last few shifts in B Pod, and the R2s are testing their taming skills in the SRU. The R3s are stepping up to the educator role, and the R4s are looking onward to their future careers. We spend these last few weeks balancing the excitement of our transitions and the purpose of our job: somewhere between the hustle and noise of B Pod, there is a critical illness waiting to be found, #beneaththesurface.

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Grand Rounds Recap - 5/25

Grand Rounds Recap - 5/25

Another month, another M&M, where this month we learned despite a great clinical rationale, there will always be cases that are a wolf in sheep's clothing. Also be sure to check out a review of chest CT indications in pregnancy, pregnancy-induced hypertension, lactate utilization in the ED and a basics course of ECMO - coming soon to an ED near you...

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Grey Matters - Recap of Flights Case 3

Grey Matters - Recap of Flights Case 3

Welcome to the Recap of the 3rd case in our Air Care and Mobile Care Flight Orientation Curriculum!

Approximately 1 month ago we presented and talked through a particularly challenging patient flight scenario.  As a refresher, if you don’t recall, check out the post here.  Following the posting of the case, I sat down with ACMC Medical Director Dr. Bill Hinckley and Resident Assistant Medical Director for Air Care, Dr. Andrew Latimer, and recorded a podcast with their reaction to the case and to some of the curveball scenarios posed in the question and discussion section.

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Peer-Peer Community Building: One of the Strongest Preventers of Burn-Out

Peer-Peer Community Building: One of the Strongest Preventers of Burn-Out

It’s nearing the end of the year, when the fourth years are moving on to real paychecks or slightly improved with fellowship, and everyone else is preparing for their new roles ahead.  The end of the academic year can feel like a period of stagnation and possibly regret.  Fear not, however, there are easy solutions and ways to prevent burn-out, the term people like to say frequently to EM physicians.  I’m not burned out! I’m just toasty sometimes!

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Clinical Concepts in CT Imaging of the Chest

Clinical Concepts in CT Imaging of the Chest

A 45 yo Female presents to the ED with sudden onset of chest pain, described as worse when taking a deep breath.  She is significantly short of breath and appears distressed.  She recently underwent a total right knee arthroplasty and reports having been bedridden secondary to pain.  Physical exam is remarkable for a right lower extremity with surgical incisions that clean, dry, intact; however, her left lower extremity is swollen with significant tenderness along the popliteal fossa and calf.  

Vitals: Temp 99.2HR 120RR: 28 BP:  130/80 SpO2 90% on RA.

A CTPA is ordered...

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Grand Rounds Recap 5/18

Grand Rounds Recap 5/18

In this week's grand rounds we covered the complications of sedation in alcohol withdrawl, the nuances of decreased door-to-needle time in acute ischemic stroke, bicarbinate use in metabolic acidosis and a case follow-up or respiratory depression in new onset myesthenia gravis

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