X-ray Vision - Shoulders and Elbows

X-ray Vision - Shoulders and Elbows

Upper extremity trauma and pain related complaints are frequently encountered in the Emergency Department. In this post, we cover the basics of the anatomy of the shoulder and elbow joint, the radiographic studies frequently performed in the evaluation of shoulder/elbow injuries, and cover some commonly encountered injuries of these joints.

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Grand Rounds Recap 10.9.19

Grand Rounds Recap 10.9.19

This week we continued our leadership curriculum with Dr. Pancioli’s lecture on the intersection of leadership and finance. This was followed by Dr. Klaszky with his R4 case follow up of a patient with cardiac tamponade, and then Drs. Baez and Continenza faced off for the most recent installment of our Great Debate series as they discussed chemical vs electrical cardioversion for atrial fibrillation. Finally, our colleagues from Cincinnati Children’s presented learning pearls about causes of and interventions for hypoxia in pediatrics emergency medicine.

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Grand Rounds Recap 10.02.19

Grand Rounds Recap 10.02.19

In this week’s Grand Rounds we discussed spinal fractures and imaging of knees and hips with our R1s, Drs. Kimmel and Gressick. Dr. Hassani from the R2 class took on Dr. LaFollette with a case of thyrotoxicosis presenting as a-fib with RVR in his CPC, and Dr. Koehler from the R3 Class taught us about heroin/naloxone-induced pulmonary edema. Dr. Golden from the R4 class discussed Fournier’s Gangrene complicated by sepsis-induced cardiomyopathy, and finally our trauma surgery colleague Dr. Pritts discussed some hot topics in trauma.

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Sepsis Journal Club Roundup

Sepsis Journal Club Roundup

The management of patients with sepsis can be exceptionally complex. As with many patient’s with complex critical illnesses, often times attention to seemingly minor aspects of the patient’s management can have significant impacts on the patient’s course of illness. In this recap of our most recent journal club, we review 3 such aspects of the care of patients with sepsis. Does the type of IV fluids really make a difference? Are steroids a friend or foe in the care of these patients? And can the simple bedside assessment of capillary refill replace serial measurements of lactate?

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Grand Rounds Recap 9.25.19

Grand Rounds Recap 9.25.19

This week Dr. Klaszky started us off with a great M&M of reviewing tPA and sumitriptan indications, EMTALA background and more. Dr. Chuko led a small group discussion of syncope rules based on his post from earlier in the week, Dr. Roblee tried to stump a faculty during her CPC of a syphilis case. Check it all out in this week’s GR Recap!

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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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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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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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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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Diagnostics: Toxic Alcohols

Diagnostics: Toxic Alcohols

Anion Gap in you obtunded ingestion patient? Weekend gone dry and friends digging through the back of the cabinet? Join Dr. Kimmel as she discusses the diagnostics and therapeutics in toxic alcohol injections and when in doubt, bookmark this for a quick review of their toxicities and metabolites.

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