Falling Out - Syncope Evaluation in the Emergency Department

Falling Out - Syncope Evaluation in the Emergency Department

Syncope is a common presenting complaint to the emergency department. Estimates suggest that 1- 3 percent of ED visits are for syncope.(1) While the large majority of these episodes are often benign, they can suggest underlying life-threatening etiologies such as arrhythmias, pulmonary embolism, and stroke. The disposition of these patients can represent a difficult quandary at times. In fact, emergency physicians are only able to establish a clear underlying diagnosis in approximately 50% of syncope patients after obtaining an HPI, physical exam and ECG. (2

Should these patients be observed in the ED? And, if so, for how long? Should they be admitted to the hospital for further workup and observation? Should they instead be discharged home with close follow-up? 

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Grand Rounds Recap 9.18.19

Grand Rounds Recap 9.18.19

This was a great week of Grand Rounds with a number of interdisciplinary presentations. The week started off with Dr. Neel presenting about common neurologic complaints in the ED in our first EM-Neurology combined lecture for the year. Dr. Jarrell then presented her R4 Case Follow Up lecture on a case of blunt pancreatic injury in non-accidental trauma. Dr. Wyrick, from the Department of Orthopedics, talked about his experiences on his global health trip to Tanzania. Finally, the week wrapped up with Drs. Iparraguirre, Jensen, and Lane leading small group workshops on orthopedic injuries.

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Is a Bag Enough?

Is a Bag Enough?

Trauma scene flights are often the first thing people think of when they think of Helicopter EMS. Although we know that HEMS and Critical Care Transport involves much more than just scene flights, they are still a critical part of most HEMS programs’ mission and capabilities. In addition, many flights are “modified scenes” or “scene intercepts,” meaning the HEMS crew meets the EMS crew at an outlying hospital helipad, or arrives shortly after the patient’s arrival to an under-resourced ED. Many of these patients are critically ill, and a subset will require intubation and ventilation. Once intubated is bag valve ventilation enough? Or should all these patient’s be placed on a mechanical ventilator?

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Air Care Series: Machines Inside of Machines - CPR in flight

Air Care Series: Machines Inside of Machines - CPR in flight

While high-quality CPR delivers the best outcomes in cardiac arrest, this is challenging in a transport environment. Dr. Connelly reviews the evidence behind mechanical chest compression in CPR, exploring its practicality to the Helicopter EMS (HEMS) environment.

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Grand Rounds Recap 9.11.19

Grand Rounds Recap 9.11.19

Drs. Winslow and Habib started the Grand Rounds off with a case-based discussion on the Centor Criteria and testing for strep pharyngitis. Drs. Walsh and Sabedra led an interesting discussion about a case of TTP. In his R4 Case Follow Up lecture, Dr. Nagle presented about DKA and family presence during resuscitation. Dr. Hogan, one of the EMS Fellows, gave a great presentation about the current controversies in cardiac arrest management. Finally, the week wrapped up with some great simulation and cases from our PEM fellows about post T&A bleeds, PTA, and acute chest syndrome.

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A Helping Hand

A Helping Hand

Medication Assisted Therapy or MAT is a critical component of the care and treatment of patients with opiate use disorder.  Over the course of the past several years, more and more ED providers, have been on the front line of initiating treatment of patients withdrawal symptoms and linking those patients to outpatient resources. In this post, we review the initiation of Buprenorphine based treatment for opiate use disorder in the ED.

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Enter the Centor

Enter the Centor

Strep pharyngitis, commonly known as “strep throat” is a bacterial infection of the oropharynx caused by group A beta hemolytic streptococci (GAS), specifically S. pyogenes. This infection affects more than 500,000,000 people annually worldwide per year, ultimately resulting in a significant number of doctor’s visits, including to the ED (1). The classic clinical presentation of GAS pharyngitis includes sudden onset of sore throat, fever, and odynophagia. If untreated, complications of GAS pharyngitis include scarlet fever, rheumatic heart disease, post-streptococcal glomerulonephritis and peri-tonsillar abscess.  In this post, we explore the diagnostic evaluation of pharyngitis with special attention to the use of the Centor criteria and rapid antigen testing.

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Grand Rounds Recap 9.4.19

Grand Rounds Recap 9.4.19

This week in grand rounds we discussed all types of critically ill patients, first covering the spectrums of hypothermia and shock. We then had a fascinating case follow up on a patient who developed torsades des pointes, and learned how to perform the HINTS exam and incorporate it into our practice. We then discussed pediatric osteomyelitis and it’s subtle presentation, and finally covered musculoskeletal ultrasound of the shoulder, knee, and ankle.

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Diagnostics: The HINTS Exam

Diagnostics: The HINTS Exam

Dizziness is common and is commonly a frustrating diagnostic dilemma in the ED. As patient’s stories vary between providers, it would be nice if we had a tool that was objective, reproducible and definitive. Enter - the HINTS exam. Join Dr. Ijaz as he discusses this nuanced exam that can change dizziness into a definitive diagnosis.

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Grand Rounds Recap 8.28.19

Grand Rounds Recap 8.28.19

This week started with a great Morbidity and Mortality Conference with Dr. Ham. Drs. Li, Makinen, Mand, and Skrobut then led small group workshops on HEENT emergencies. Following this, Dr. Harty led a fascinating discussion about a patient with Carotid Blowout Syndrome and Dr. Lagasse presented some of her work on trauma care and prevention from a Global Health perspective. The week wrapped up with Dr. LaFollette discussing arthrocentesis and joint loading in the emergency department.

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Grand Rounds Recap 8.21.19

Grand Rounds Recap 8.21.19

This week in grand rounds we started off reviewing the importance of matching the minute ventilation post intubation with airway master Dr. Carleton. We also reviewed salicylate overdose treatment with Dr. Owens as well as common and life threatening SCUBA emergencies with Dr. Comiskey. Finally, we finished the week off with a severe calcium channel blocker overdose and reviewed the treatment strategies to combat this extremely deadly overdose.

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

Damage Control Resuscitation, Permissive Hypotension, Fluid Restrictive Resuscitation… Regardless of name, with all the enthusiasm surrounding permissive hypotension in the actively bleeding trauma patient, what do we do when they have a TBI? Take a dive into the literature surrounding ideal perfusion pressures of patients suffering from TBIs and traumatic injury to find out if we know what pressure is really the best.

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Grand Rounds Recap 8.14.19

Grand Rounds Recap 8.14.19

This week we had a great mix of lectures on both pediatric and adult topics. Topics covered included pediatric ear, nose, and throat emergencies with Dr. Smith, pediatric GI bleeding with Dr. Bensman, anticholinergic poisoning and treatment of the critically ill seizing patient with Dr. Gleimer, a fascinating case of disseminated gonnorhea during of CPC with Drs. Berger and Baez, how to interpret volatile acid testing including the osmolar gap, and finally a great summary on the current standard of the diagnosis of subarachnoid hemorrhage with Dr. Murphy Crews.

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