Grand Rounds Summary 8/12/15

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Grand Rounds Summary 8/12/15

VISITING LECTURER SERIES WITH DR. MATT DAWSON

1) On Technology, Emergency Medicine, and New Frontiers

Today’s tech explosion is leading to health innovations that may make some big differences leading to big changes. Here’s a sneak peak:

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Thromboelastography aka The TEG

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Thromboelastography aka The TEG

What is TEG?

Thromboelastography (TEG) measures the dynamics of clot development, stabilization/strength, and dissolution. Assuming the body’s ability to achieve hemostasis is a function of these clot properties, TEG provides specific, real-time indicators of a patient’s in vitro hemostatic state. This is in contrast to routine screening coagulation tests such as aPTT and PT/INR which are run with blood plasma alone and therefore do not take into account the cellular components of clotting.

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Grand Rounds Summary 8/5

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Grand Rounds Summary 8/5

Taming the SRU Case Follow-Up: GSW to the Head with Dr. Grosso

  • In one census: 66% of violent deaths are suicide, with 30k suicide deaths annually in the US
  • ~50% of suicide attempts include firearms
  • GSW to head mortality is 80%, and 71% die on scene
  • ~40% of those who survive to hospital have favorable outcomes
  • Favorable prognosis: GCS>8, normal pupillary reaction, absence of coagulopathy of trauma/hemodynamic instability
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Grand Rounds Summary - July 29th, 2015

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Grand Rounds Summary - July 29th, 2015

Morbidity and Mortality Pearls with Dr. Curry

Nephrolithiasis

Incidence in the US is 0.5-1% (lifetime risk 10-15%). There is a 2:1 male predominance and the recurrence rate is fairly high (37% at 1 year, 50% at 10 years and 75% at 20 years).

Patients at risk for poorer outcomes with ureterolithiasis are those with risk factors for diminished renal function, history of difficulty with stones/urologic intervention and symptoms of infection.

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Moonlighter - Recap

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Moonlighter - Recap

This is our final recap of our "Out on a Limb" Case Series!  If you missed the initial "Moonlighter" case and discussion you can check it out here.  There were a number of great responses to the questions which we'll recap below.

Q1 - What are your options in handling this situation?

You have a few options in handling this situation. As many of the respondents chimed in, the wound definitely needs to be cleaned out and closed and the patient requires antibiotics as soon as is reasonably and safely possible, especially since the injury is already 6 hours old. The first option is to complete a sedation and multilayer repair in the ED yourself. As many people point out, this is not an excellent proposition unless there are extreme extenuating circumstances.

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Trouble Abroad - Recap and Commentary

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Trouble Abroad - Recap and Commentary

The responses provided so far have been phenomenal, both insightful and provocative.  I am truly impressed.  As mentioned by several of my colleagues, many of these cases are deeply personal, not only because they involve highly vulnerable populations, but also because they may put clinical providers in harm’s way.  When we begin to discuss ethics, especially global health ethics, there is often no single correct answer to a given scenario.   We often deal with hard science and hard facts but sometimes you just have to go with your gut and do what you think is right.  If you missed the first case and initial discussion, check it out here.

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Grand Rounds Summary - July 22

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Grand Rounds Summary - July 22

Dr. Miller - Leadership Curriculum

"Give me six hours to chop down a tree and I will spend the first four sharpening the axe" - Abraham Lincoln

In order to lead the team, you need a reflection of what you need to improve as a leader:

  • In a survey of academic chairs, communication, decision making, collaboration and trustworthiness were the top rated characteristics
  • In a survey of UC EM residents and faculty confirmed that these apply to every level of training
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Grand Rounds Summary - July 15

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Grand Rounds Summary - July 15

Oral Boards

African Tick Borne Illness

  • Rickettsial illnesses (specifically Africae)
  • Empiric doxycyline & ID consultation for presumed tickborne illnesses
  • Rickettsia africae classically presents 4-7 days post exposure with thromobocytopenia and hyponatremia

Hypothermic cardiac arrest

  • Fixing the temperature is the most critical thing
  • EKG findings of Osborne waves in hypothermia
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The Little Things that Matter

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The Little Things that Matter

We were fortunate, a couple weeks back, to have Dr. Brian Burns of Sydney HEMS come and speak to us.  In his lecture, “When the 1% Makes All the Difference” which you can find here, Dr. Burns hit on a number of excellent points.  We sat down and talked with Dr. Burns a bit more extensively over a couple of the themes of his lecture.

In this podcast, we cover some of the plus/minuses of checklists, the importance of high fidelity continuous training practices (simulation, routine case debriefing, intensive induction training), and the role of cognitive factors in running resuscitations.

Should resuscitations run like a jazz quartet or a Formula 1 pit crew?  Are checklists simply in the way or do they cognitively unload the team members to improve performance?  How do you train cognitive factors in resuscitation?

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When That 1% Makes All the Difference

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When That 1% Makes All the Difference

Just prior to SMACC (the Social Media and Critical Care Conference), we were lucky enough to have Dr. Brian Burns of Sydney HEMS stop through Cincinnati.  In the video below you can see his lecture on when the 1% makes all the difference.  Dr. Burns talks about how we should strive for excellence in prehospital care not simply meeting minimum standards.  Watch the lecture below to hear Dr. Burns discuss the importance of incremental changes, cognitive offloading, checklists, and continuous improvement and training through simulation.

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Annals of B Pod - Summer Issue is Here!

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Annals of B Pod - Summer Issue is Here!

In July, the entire emergency department is full of firsts; firsts shift in a new pod, first solo flights, first successful codes, and first shifts supervising new providers. This is an exciting time -- full of new faces and new roles. July can also be scary. All of those new roles come with uncertainty, fear of the unfamiliar, and immense responsibility.
This issue features cases and #lessonslearned from graduates whose “firsts” were not so long ago. These are showcased to serve as a reminder to us all that although this month is full of firsts for the residents, our faculty, nurses, and department have seen many Julys pass and are ready and eager to teach us their own #lessonslearned. Check out the new issue to see!

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"Flights" - Shaken Recap & Expert Commentary

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"Flights" - Shaken Recap & Expert Commentary

Thanks to everybody who commented and contributed to the discussion on our final “Flight!”  If you missed out on the case, check it out here. Below you’ll find a curation of the comments to each question and a podcast with expert commentary from Jenn Lakeberg, APRN.  This was the final “Flight” for this spring/summer.  Look for the cases to return again in January 2016 as we begin Flight MD Orientation with the next class of future Air Care Flight Docs.

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Annals of B-Pod: #lessonslearned

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Annals of B-Pod: #lessonslearned

Beware! Aortic Dissection

#lessonslearned is a case series submitted by former senior residents describing B-pod cases that taught them the art of medicine

Case 1

A male in his 30s with a past medical history significant for hypertension presented via EMS with pain all over, anxiety and shortness of breath. The EMTs reported that he had smoked marijuana about 30 minutes before his presentation from his normal supply. At the scene he was noted to be very agitated, diaphoretic and vocal about his pain. He was yelling that he was hurting all over, he was having trouble breathing, and that he wanted to be sedated. He states that he has never had problems like this.

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