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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Grand Rounds Recap 11.14.18

Grand Rounds Recap 11.14.18

We had a great Grand Rounds line-up this week - Dr. Whitford started us off with a challenging case of altered mental status that took a variety of twists and turns highlighting the need for reassessment flexibility in your differential diagnosis in the critically ill patient. Next up was Dr. Koehler and Dr. Betz who led us through a case of septic arthritis which presented atypically as altered mental status. Dr. Edmunds then provided us with emergency presentations of pediatric vomiting. Lastly, we closed the day with Dr. Roblee’s excellent case-based discussion on the evaluation and management of hypertension in pregnancy.

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Air Care Series: Burns Management

Air Care Series: Burns Management

Severely burned patients can be intimidating for even the most seasoned critical care transport providers. These patients often require aggressive resuscitation and multiple procedures in a relatively short period of time. It is often easy for providers to become overwhelmed, necessitating an algorithmic approach to the patient, similar to traumatically injured patients, is crucial. By advancing through the primary survey and stabilizing the patient while starting aggressive but goal directed crystalloid resuscitation, critical care transport providers can bring ICU level care to one of the sickest pre-hospital patient populations.

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Grand Rounds Recap 11.7.2018

Grand Rounds Recap 11.7.2018

Enjoy the review of this week’s Grand Rounds! We began the morning with Dr. Minges giving us his pro-tips on how to identify cardiac tamponade with ultrasound. Following this, we learned about high-yield management pearls about Carotid Blowout Syndrome and SCIWORA from Dr. Scanlon and Dr. Baez respectively. We concluded the day with AirCare Grand Rounds, where we learned how to deal with refractory hypoxia, postpartum hemorrhage, and utilize the V-scan for ultrasound.

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Air Care Series: Balloon Tamponade of Variceal Hemorrhage

Air Care Series: Balloon Tamponade of Variceal Hemorrhage

In HEMS, there are rare instances where ‘stay and play’ is the safest thing for the patient. Exsanguinating variceal bleed is one of those conditions. This week Dr. Whitford takes us step-by-step through the placement and confirmation of balloon tamponade placement (Minnesota Tube) for stabilization of these bleeds. We hope by reading this, it gives you another 6 months of this not happening on your next transport or ED shift...

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Grand Rounds Recap 10.31.18

Grand Rounds Recap 10.31.18

We had a diverse and interesting set of topics for this week of Grand Rounds! Dr. Mehlman, a pediatric orthopedist, took us through high-yield, can’t miss orthopedics cases. Following this, we went through strategies in team-building and recruitment with Drs. Stettler, Fermann, and McDonough as part of our Leadership Curriculum. Dr. Jarrell then presented local data on our Naloxone Distribution program and opioid overdoses. We concluded the day with a lecture on hernia diagnosis and management by Dr. Leech, followed by a fantastic small group session on Wellness lead by Drs. Jarrell and Banning. Enjoy our summary of these high-yield topics!

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The Mighty Paper Clip

The Mighty Paper Clip

You’re working in the ED on a busy Halloween evening. So far you have seen patient’s in all manner of costumes.. 2 Donald Trumps, 1 Santa Claus, a father-daughter pairing of Beast and Belle. Your next patient is dressed as Kylo Ren. He is a 16 yo M who was out trick or treating with some friends when they started to play fight with their lightsabers.  He was attempting to block a strike when his friends lightsaber bounced off his and hit him in the right eye.  He immediately had severe pain in the eye and face and noticed some loss of vision.  He went home and showed his parents who brought him to see you in the ED.

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Grand Rounds Recap 10.24.18

Grand Rounds Recap 10.24.18

It was an exciting week of Grand Rounds where Dr. Colmer presented our monthly Morbidity and Mortality conference. We had a fantastic guest lecturer, Dr. Reuben Strayer (@emupdates), who discussed opioid abuse and airway management. Finally, our consultant of the month was Dr. Amy Makley who discussed blunt abdominal trauma. Take a look!

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