Last week we had our first Journal Club of the year and had an excellent discussion of the evidence surrounding the use of amiodarone, lidocaine, and procainamide for ventricular dysrhythmias. Take a listen to the podcast below and read up on the details of the papers below that!
Read MoreAcute Coronary Syndrome in Pregnancy
Epidemiology
Risk Factors
Many of these are typical ACS risk factors but are less prevalent in the pregnant population
Last week our residents and faculty met for journal club in search of the holy grail.. err.. I mean, to talk about ways to assess volume responsiveness. A couple of weeks back the PGY-1 and 2 residents met and discussed a number of questions they had about the care and management of patients with sepsis. The discussion hit on a number of key topics: empiric antibiotic selection, timing of antibiotics, choice of vasopressors, etc. Ultimately the group decided they wanted to take a closer look at non-invasive ways to assess volume responsiveness and guide resuscitation in septic patients.
Read MoreIt's a typical busy post-Thanksgiving shift in the ED. It seems like patients with acute decompensated heart failure, sepsis, NSTEMI's and a whole host of other ailments are tucked in every corner and crevice of the ED. Just as you finish putting in orders on the last patient you saw, your next patient rolls by on an EMS stretcher. You see from your computer that the patient is on a backboard and in a c-collar after what clearly was some form of traumatic event. He's screaming in pain and holding his left leg flexed at the hip and internally rotated. "Jeez, I bet that hip is dislocated," you say to yourself.
You know you're going to need to reduce this dislocation, to not do so would risk avascular necrosis. Tammy, one of the nurses you are working with that day is already 2 steps ahead of you. "Doc, we're getting everything set up for the sedation, you're going to need for that hip that's out. What drugs do you want us to pull up?"
Read MoreA couple weeks back we met for the first journal club of the year in our residency. For this first session, we tackled the clinical conundrum of transfusion ratios in trauma. The question came from a brainstorming session with the PGY-1 and 2 residents, where the following PICO question was derived:
Patients: Victims of both blunt and penetrating trauma in need of blood transfusion as a part of the their initial resuscitation
Intervention: high plasma and platelet to PRBC ratio transfusion
Comparison: low plasma and platelet to PRBC ratio transfusion
Outcome: Mortality (in patient and 30 day mortality)
Read MoreLike many other Emergency Medicine residencies, we took the time in our last Journal Club to break down the Targeted Temperature Management Article. There is tons out there in the #FOAMed space about this trial. And, one of our 4th year residents, Dr. Trent Wray, took some extra time to break down the article in gory detail and put it into the context of the previously published literature.
Read MoreEvidence Based Clinical Practice (EBCP) is a way to bring the sometimes obtuse world of evidence based medicine to the bedside. Instead of getting lost in p-values, ANOVA, student t-tests, multivariate logistic regressions, EBCP approaches evidence based medicine always through the lens of a patient under a clinician's care. It is a process that starts with asking carefully crafted questions and efficiently searching for answers to those questions. Subsequent analysis of the articles found in the clinician's searching seeks to answer: are the results valid? what are the results? and finally, how can one apply the results to patient care?
In this short video, we go through the crucial initial step of the process: asking a question. Success in asking answerable, well crafted questions begets successful search strategies.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
