Don't Kill the Beans: The Specter of Contrast-Induced Nephropathy

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Don't Kill the Beans: The Specter of Contrast-Induced Nephropathy

Working in the Emergency Department, we often encounter patients with either pre-existing renal disease or an acute compromise of their renal function who also have a disease process necessitating a contrasted radiology study.  So what do we do with that patient with a creatinine of 1.8 who has a possible vascular dissection/traumatic injury/infection? What is the risk of contrast to that patient?  Should you compromise your diagnostic evaluation to avoid a harm to the patient's renal function?  Dr. Nick Ludmer, Dr Michael Miller, and Dr. Amanda Polsinelli recap 3 articles recently published looking into contrast induced nephropathy.  Take a listen to the podcast and read the blog post to get yourself acquainted with the current state of the literature.

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Grands Rounds Recap 4.26.2017

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Grands Rounds Recap 4.26.2017

Dr. McKean kicked off this week with another great M&M where he taught us about the utility of stress testing to predict coronary artery disease, otomastoiditis, and much more. Dr. Brenkert joined us for an hour on pediatric musculoskeletal ultrasound and then Dr. Mudd reviewed transfusion strategies in upper GI bleeding. Dr. Ventura taught us about CSF analysis and Drs. Stettler and Whitford rounded out the day with a CPC about acid-base disturbances. 

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What's in a Tap: CSF Analysis

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What's in a Tap: CSF Analysis

Lumbar punctures are common procedures to the Emergency Medical provider.  Obtaining the fluid is just part of the battle however with this procedure.  With the flood of results often comes a fair bit of confusion as to how to interpret them.  After reading this post, you'll be able to:

  • Use cell counts, protein, and glucose to distinguish between various etiologies of meningitis and determine when to order further testing
  • Understand markers of bleeding in CSF and methods of distinguishing SAH from traumatic tap

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Grand Rounds Recap 4.19.2017

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Grand Rounds Recap 4.19.2017

This week kicked off with a Tox filled R4 Simulation where we learned about ASA, digoxin, and hydrofluoric acid toxicities. This was followed by lectures on cardiac disease in diabetes, pediatric pain management strategies, physician burnout and hypothermic cardiac arrest. 

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Grand Rounds Recap 4.12.2017

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Grand Rounds Recap 4.12.2017

This week in Grand Rounds: lessons learned in mass casualty from our recent experience with a mass shooting, a case of abdominal pain in a patient with a TIPS, understanding the UA, the importance of diagnosing HIV in the emergency department, dental emergencies, point of care ultrasound in pediatrics, and a deep dive into the literature about management of low risk PE.

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Back to the Basics: Demystifying the UA

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Back to the Basics: Demystifying the UA

Amongst the various diagnostic studies that can be obtained in the ED, urinalysis is a virtually ubiquitous test. Urine itself reflects the functioning of the human body in both health and disease and the values it comprises can give us information regarding a myriad of conditions from infections, metabolic or endocrine derangements, and toxidromes to neoplastic processes and pregnancy. Despite this, many of the elements of even the standard urinalysis are often overlooked and underappreciated. In this talk we will explore some of these values and hopefully gain a renewed respect for the “golden cup of answers” and all that it may reveal.

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Vasopressin: A Second Class Pressor?

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Vasopressin: A Second Class Pressor?

This week we'll be recapping the discussion of our most recent journal club where Dr. Christian Renne, Dr. Anita Goel, and Dr. Maika Dang led us in a discussion centering on the use of vasopressin both in sepsis and in vasoplegic shock states.  Take a listen to the podcast below and read the brief summaries of their articles to boost your understanding of Vasopressin.  Should you reach for it first or is it a second class pressor?

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Grand Rounds Recap 3.29.2017

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Grand Rounds Recap 3.29.2017

Dr. Grosso kicked off Grand Rounds this week with March M&M by diving deep into some core content, including BB and CCA overdoses, influenza, massive transfusion, post-intubation hypotension, and neurological catastrophes causing cardiac arrest. Dr. O'Brien broke down coagulopathy of liver disease and DIC for us while Dr. Golden taught us about febrile seizures. Drs. McKee and Colmer talked through the evidence behind their CPQE pathway on vent management in obstructive lung disease. Drs. Liebman and Powell went head to head in a CPC case about sternal osteomyelitis to round out another excellent week of learning. 

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Global Health Videos

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Global Health Videos

Care of the acutely ill patient in the austere setting is a hallmark of Global Health Medicine. These videos highlight three different examples of how to apply core concepts of Emergency Medicine to a resource limited environment. Dr. Lagasse describes how to make a homemade tourniquet to control life-threatening hemorrhage, Dr. Teuber shows us alternatives to intravascular volume resuscitation, and Dr. Roche outlines how to manage pneumothorax, hemothorax, and hemopneumothorax with and without vacuum assistance

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Cardiac Biomarkers

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Cardiac Biomarkers

Real time, high sensitivity serum biomarkers have played an enormous part in the timely identification and intervention on of cardiac pathology in the Emergency Department. These biomarkers have sufficient sensitivity to identify cardiomyocyte injury even in the absence of physical exam, radiographic, or electrocardiographic findings. Unfortunately, the utility of these studies may be limited or obfuscated in certain clinical contexts. This article will discuss the possible pitfalls and obstacles physicians may encounter in interpreting cardiac biomarkers

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Grand Rounds Recap 03.15.17

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Grand Rounds Recap 03.15.17

This week, Dr. Boyer led us through his R4 case follow up. Drs. Baez and Summers dove deep into the literature on sepsis. Dr. Gauger reviewed toxicologic syndromes. Dr. Axelson hit us with some trauma pearls and we worked through sick respiratory cases during our combined Peds-EM sim. 

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Annals of B-Pod: Spring Issue Release!

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Annals of B-Pod: Spring Issue Release!

The topics covered in this Spring’s installment of Annals of B Pod highlight the variety of medical knowledge and procedural skills used daily in the Emergency Department. In B Pod, there may be a patient with an intentional ingestion brought in by EMS next door to a patient with a cough who is discovered to have pneumonia, while on the other side of the pod there is a patient complaining of eye pain. All of these patients represent common chief complaints with broad differentials that interns learn how to work up, manage, and treat. Spring also marks a transitional time, when interns start stepping up to into the junior resident role. With this transition, interns broaden their procedural skill set by learning how to place central lines, perform intubations, and insert chest tubes. As the year progresses, interns see more pathology, learn about new disease processes, and acquire procedural skills.

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