Ultrasound Case of the Month: An Unexpected Mole

Ultrasound Case of the Month: An Unexpected Mole

Part of the power of bedside ultrasound is the ability to make a diagnosis within seconds of image acquisition. Join Dr. Golden as he takes us through a fascinating case of early pregnancy guided by POCUS in the emergency department and the unexpected finding that, while rare, can dramatically alter the patient’s ED course.

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Grand Rounds Recap 5.8.19

Grand Rounds Recap 5.8.19

Welcome to another installment of the Grand Rounds Recap! We had an excellent series of lecturers that we are very excited to share with you. We started off the day with our visiting lecturer Dr. Noble who presented a some excellent pearls on how to better incorporate lung ultrasound in the management of our patients in the ED. Next up Dr. Mand and Dr. Lagasse went head to head in our clincopathologic case series. Dr. Lagasse nailed the diagnosis of Dengue hemorrhagic fever and Dr. Mand then educated us on how it can progress to shock. To follow came Dr. Pulvino who lead us through some small group cases on the utilization of the PERC criteria and Wells score in the evaluation of patient with a potential pullmonary embolism. Next was Dr. Connelly who presented on the evaluation and management of patients with conditions resulting from ascent to high altitudes. To wrap up the day Dr. Lipshaw demystified the pediatric rash patient.

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Tidal Volume Strategies for those without ARDS

Tidal Volume Strategies for those without ARDS

 Invasive ventilation is one of the most frequently applied interventions utilized for critically ill patients.  However, as with all medical interventions, there are potential risks and harms which must be balanced with perceived benefit.  As our understanding of physiology grows, we have found more and more potential harms associated with invasive mechanical ventilation. This review of a recent article published in JAMA explores the impact of different tidal volume strategies for patients who do not have ARDS.

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PERCs of the Wells Score

PERCs of the Wells Score

Pulmonary embolism (PE) is one of the big “can’t miss” diagnoses in the emergency department. Unfortunately, presenting symptoms are often vague, and definitive diagnostic testing is expensive and comes with risks of radiation and contrast to the patient. In order to avoid missing a PE while mitigating the risks associated with overtesting, some clinical decision tools have been created to aid in the diagnostic process. We will focus on two of these commonly used decision tools: the PERC rule and the WELLS score for PE.

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Grand Rounds Recap 5.1.19

Grand Rounds Recap 5.1.19

We had an exciting Grand Rounds this week. We started off with our visiting lecturer, Dr. Jennifer Wiler, who gave us an excellent overview of the dollars and cents behind the care that we provide in the emergency department. Afterwards we practice some oral board style cases. Dr. Betz led a challenging triple patient encounter where we had to simultaneously manage a knee dislocation, aortic dissection with involvement of the right coronary artery, and pneumonia in the setting of HIV. Dr. Curry led a riveting case of preeclampsia where identifying the critical history of a recent delivery was critical to initiating the correct management. We wrapped up the day with a simulation led by Drs. Hill, LaFollette, and Lang on in-flight emergencies!

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A Headache with Consequences - Temporal Arteritis

A Headache with Consequences - Temporal Arteritis

This will mark the third and final recap of the March 2019 asynchronous small group cases.  Feel free to take a look and listen back at Parts 1 and 2.  This post we’ll be covering the presentation fo a middle aged female with a headache.  The differential is broad and fraught with a number of life/limb/sight threatening diagnoses.  As with the previous recaps, we recorded a podcast where we walk through the presentation, initial work up and management.

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Grand Rounds Recap 4.24.19

Grand Rounds Recap 4.24.19

This week’s grand rounds started off strong with Morbidity and Mortality led by Dr. Baez. She discussed a wide variety of topics including stress testing in the ED, precautions, hearing loss, aspiration, and tamponade. Dr. Randolph followed this up with an insightful discussion on high risk ED discharges. The Global Health Team then shared some of the fascinating cases they encountered overseas. Dr. Sabedra reflected on how much we learn from each other by giving a heartfelt talk on what she has learned from her fellow R4’s. We continued with Dr. Gawron reviewing the many cervical spine rules and how to properly apply them. To conclude, Drs. Skrobut and Roche went head to head in this weeks CPC. Who wins? Read on to find out.

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Air Care Series: A Case of Massive Clot

Air Care Series: A Case of Massive Clot

Shan Modi, MD walks us through a critically ill patient with pulmonary embolism then breaks down the literature surrounding the management of Pulmonary Embolism both in the Emergency Department and Critical Care Transport Environment. We will cover fluid support, vasopressor usage, ventilatory management, vasodilators, ECMO and more!

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The Return of Droperidol...

The Return of Droperidol...

Have you heard the news! Droperidol is back and available in the United States.  After a prolonged hiatus the medication has been picked up by a new manufacturer and may be finding its way to a hospital pharmacy near you.  Since it has been some time since the medication has been in common use, and since the memory of its effectiveness may be buoyed by a sense of nostalgia or otherwise viewed through rose colored glasses, now is as good a time as any to take a stroll through the literature and learn a bit more about the effectiveness and side effect profile of the medication.

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Diagnostics: C-Spine Rules

Diagnostics: C-Spine Rules

Clearance of cervical spine is more within the house of Emergency Medicine than anywhere else, so it implores that when we clear a cervical spine using our rules, we take a second to consider the sensitivity, specificity and even more importantly the exclusions that were used in the derivation and validations in these studies. Dr. Gawron takes a look through these rules for our review

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Grand Rounds Recap 4.17.19

Grand Rounds Recap 4.17.19

Enjoy this weeks Grand Rounds Summary. We had a great small group session on conflict resolution presented by Dr. McDonough and Leenellett of the leadership curriculum team. Next, Drs. Iparraguirre and Li taught us about an evidence-based approach to epistaxis. We completed our morning going through a great simulation on Acute Myocardial Infarction requiring Thrombolysis with Drs. Colmer, Mckee, Harrison, and Continenza.

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Grand Rounds Recap 4.10.19

Grand Rounds Recap 4.10.19

Have fun reading this week’s Grand Rounds Recap! Dr. McDonough provided an insightful talk on Physician Depression and Wellness to start our morning. Following this, we had an excellent session on TEG’s multitude of uses in the ED. We had a variety of ophthalmology pearls shared by Drs. Owens, Scanlon, Ventura, and Harty. Then, Dr. Krack, one of Cincinnati Children’s Hospital’s Pediatric EM fellows shared helpful hints in taking care of pediatric patients with Congenital Heart Disease. Next, Dr. Pulvino shared her clinical diagnostics lecture on Platelet Disorders. Dr. McKee finished our day with an exciting talk on medical ethics and how they apply to the Emergency Department. Enjoy!

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