Grand Rounds Summary 10.4.17

Grand Rounds Summary 10.4.17

This week Drs. Jarrell and Nagel kicked off Grand Rounds with their evidence based review of the hypertension management in the ED. Drs. Gorder, Lagasse, O'Brien, and Polsinelli discussed the difficult management of the patient in both cardiogenic and septic shock, reviewed heart murmurs, and endocarditis. Dr. Bryant made us squirm with her Global Health quick hit case review of parasitology, Dr. Lane led a great group discussion about the utility of procalcitonin in adults, and Drs. Habib and Roche ended Grand Rounds with a great CPC case!

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Pro's and Con's of Procalcitonin

Pro's and Con's of Procalcitonin

Procalcitonin was reviewed on Taming the SRU in the context of other biomarkers (ESR, CRP) last year with a grand rounds discussion of its utility in the setting of a febrile 7 week old. As procalcitonin has continued to gain traction in the world of pediatric EM – receiving evaluation as part of proposed protocols for management of febrile infants (1) and for its utility as an aid to diagnosis of Serious Bacterial Infection (2,3) – we turned our attention this year to procalcitonin’s use in adults. Procalcitonin testing has been studied and available for decades (as St. Emlyn’s noted in an update earlier this year), but has not really established itself in widespread use in adults (as EMDocs noted in a sepsis update in 2014). In this blog post, we take the approach of going back to what is known (and is NOT known) about the biochemical basics of this molecule to give context to the sometimes confusing smorgasbord of proposed applications for procalcitonin testing that exists in the literature.

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Grand Rounds Summary 9.27.17

Grand Rounds Summary 9.27.17

Dr. Titone held a great in-depth M&M this month with cases from tuberculosis to typhilitis (which is a thing). Drs. Baez and Goel took us through cases of coding Torsades and coding Pine Sol ingestions, followed by Dr. Skrobut who delicately closed the day with a discussion of testicular complaints in the ED.

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Grand Rounds Summary 9.20.17

Grand Rounds Summary 9.20.17

This week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls.  This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate.  Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula.  Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine.  Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.

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The Future of Airway Management?

The Future of Airway Management?

What is the future of airway management in the ED?  How can we make our practice more effective and more efficient?  In this journal club recap, we focus on 2 topics emerging in the literature - flush rate O2 for pre-oxygenation and head of bed elevation during intubation.

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

Since the turn of the century, lactate has become a mainstay in emergency medicine and critical care laboratories. Some clinicians may hate it, others may love it, but very few can feign apathy on the subject. The utility of lactate in the emergency department and the ICU in guiding resuscitations, predicting mortality, or identifying occult critical illness continues to be discussed in the literature, most fervently in the realm of sepsis. But what are the humble beginnings of this molecule? Most fundamentally, how is lactate generated in the setting of critical illness? And how did it come to be so firmly embedded in our understanding of the pathophysiology of critically ill patients?

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Grand Rounds Summary 9.13.17

Grand Rounds Summary 9.13.17

'Twas a fantastic grand rounds.  Drs. Banning and Golden started it off taking us through the most recent evidence for management of sub-massive and massive PE, as well as presenting their algorithm to be published on Emergency KT.  This was followed by a global health lecture given by Dr. Lagasse, which covered a range of re-emerging infectious diseases.  Next, Dr. Bryant took us through multiple pediatric cases, and discussed her approach in determining whether to discharge, transfer, or treat pediatric patients with common / representative complaints.  Dr. Adeoye then took us through the history and development of our current approach to the management of acute ischemic stroke.  Dr. LaFollette then took us through an evidence based approach to removing things from where they shouldn't be in his edition of mastering minor care, discussing approaches to removing retained objects from ears and skin.  We then finished the conference with two interesting cases:  One presented by Dr. Sabedra that was followed by a discussion on the diagnosis and management of massive hemoptysis, and the other presented by Dr. Dang illustrating the differences and similarities hyperthermic toxidromes including NMS and serotonin syndrome as well as their management.  

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Grand Rounds Summary 9.6.17

Grand Rounds Summary 9.6.17

Dr. McKinney from our MFM service started us off with some pearls of 2nd and 3rd trimester complications and management. Drs Murphy, Liebman, McKee and Whitford taught small groups about tips and tricks of extensor tendon repair, hip ultrasound and compartment pressures. Dr. Hughes gave us a talk on plain film utility in the ED and finally Drs. Scanlon and Doerning faced off in a CPC of a case of HELLP syndrome.

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Soft Tissue Neck Radiographs - Are They Useful?

Soft Tissue Neck Radiographs - Are They Useful?

In March 2015, Dr. Renne did a Grand Rounds lecture on soft tissue neck radiographs, which offers a great review of normal anatomy and systematic approach to reading films (“CHESS”). Yet, in my small, informal (not scientific at all) poll of some of our residents, none had ever ordered a soft tissue neck film. Are soft tissue neck radiographs useful? You be the judge. 

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Grand Rounds Recap 8.30.2017

Grand Rounds Recap 8.30.2017

This week Dr. Gorder led us off with August's M&M cases, followed by Dr. Betz giving us great in-depth example of a proper joint exam from the perspective of sports medicine. Dr. Makinen gave us a talk of accidental hypothermia, Dr. Ludmer examined the link between chronic pain and depression and how concurrent treatment can help our patients quality of life. Dr. Wright gave us an update on UCEM Global Health and Dr. Colmer gave us a look into the critical care management of a DKA case.

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Troublesome Tracheostomies

Troublesome Tracheostomies

Troubles with tracheostomy tubes can be some of the most anxiety provoking complaints we see in the Emergency Department.  Airway master and Dr. IC Cordes himself, Dr. Steven Carleton, MD PhD joined me on the podcast to help demystify 2 common tracheostomy related complaints - the bleeding trach site and the displaced tracheostomy tube.

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Grand Rounds Recap 8.23.17

Grand Rounds Recap 8.23.17

Dr. Carleton started things off with a review of oral fiberoptic intubation and a step by step guide to trach recanalization. Next we headed off to EM-Neuro combined conference where Dr. Neel discussed headaches that kill, headaches that maim and headaches that annoy. Dr. Thompson walked us through a case of vertebral artery dissection and Dr. Liebman kicked off our wellness curriculum. Dr. Roche finished things up with a discussion the nuances of toxicology in the community. 

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The Radioactive Heart

The Radioactive Heart

For Journal Club this past week we covered what is undoubtably one of the more controversial diagnostic tests used in the evaluation of patients presenting to physicians with chest pain.  The most recent NICE guidelines recommend Coronary CT as the first line test for patients with stable angina symptoms but don't Coronary CT's lead to increased downstream testing? more radiation exposure? To investigate this topic we took a look at 3 articles focused on the utility of Coronary CT scans. Take a listen to the podcast and read the recap to learn for yourself.

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