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.

Read More

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.

Read More

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.

Read More

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.

Read More

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!

Read More

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.

Read More

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.

Read More

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!

Read More

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.

Read More

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!

Read More

Grand Rounds Recap 10.17.18

Grand Rounds Recap 10.17.18

This week we started off with Drs. Gleimer and Koehler running through the new ‘early, often and subQ’ QI/KT protocol for Sickle Cell Disease. Dr. LaFollette then discuss the oft-ignored complaint of hemorrhoids and peri-anal abscesses. We got snapshots from resident attendees of ACEP and Dr. Continenza discussed a case of postpartum hemorrhage resuscitation.

Read More

Grand Rounds Summary 10.10.18

Grand Rounds Summary 10.10.18

From epi drips to peds fracture tips, it was an eventful Grand Rounds. We began with a debate on the utility and method of epinephrine during cardiac arrest. Dr. Murphy then discussed hemodialysis access complications followed by Dr. Palmer’s operations update. Dr. Shah led a discussion on the recognition and management of pediatric fractures. We concluded by covering a variety of other pediatric topics during the R3 small group session. Take a look!

Read More

A Weakness in the HEART?

A Weakness in the HEART?

In this month’s Journal Club Recap we take a look at some recently published literature about common heart related complaints in the ED. First, we look at the now nearly ubiquitously used HEART pathway. In a US population, do the benefits of decreased health care utilization sustain themselves to a year out of an index visit? Then we turn our attention to atrial fibrillation with RVR. Does the utility infielder of ED medications, Magnesium, actually help with more rapid rate control? And, should the results of a consensus panel sway us to treat A fib with RVR as an outpatient?

Read More

Grand Rounds Recap 9.26.18

Grand Rounds Recap 9.26.18

This weeks grand rounds started off with our Morbidity and Mortality conference led by Dr. Shaw who led us on an education expedition covering the use of REBOA, surgical vs. medical management in spontaneous miscarriage, ways we can improve our use of the electronic medical record, management of a persistent air leak in a patient with a chest tube, and the role of CT in CAP. Dr. Alwan then provided us an in-depth look at the often untold challenges of life as a refugee as well as the challenges we face in providing care for these patients. This was followed by Dr. Randolph who presented a case of an incredibly complicated patient with a pulmonary embolism to highlight the steps in management of a decompensating patient with a pulmonary embolism before you initiate thrombolysis. Next up was Dr. Gottula and Dr. Hinckley who went head to head with a challenging presentation of acute aortic dissection as part of our CPC lecture series. Dr. Leech then finished up the day with a case based discussion on the utility of the Kocher Criteria in the evaluation of child with an acutely painful hip.

Read More