When the Easy LP Isn't Easy

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When the Easy LP Isn't Easy

Lumbar punctures can be mercurial procedures.  There are certainly patients in whom it can be predicted that a lumbar puncture will be challenging.  Obesity, patients with known degenerative changes, and agitated patients all present unique challenges when it comes to successfully completing a lumbar puncture.  There are patients, however, who throw you a bit of a curveball.  Sometimes cooperative patients with good landmarks, in whom you had every expectation that you would find success, become seemingly impossible to successfully complete a lumbar puncture.  

For the provider, knowing how to troubleshoot the unexpectedly difficult lumbar puncture can be the difference between success and failure.

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Grand Rounds Recap 2.7.18

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Grand Rounds Recap 2.7.18

This week Dr. Carleton kicked off a lecture series on the pediatric airway by discussing some anatomic and physiologic challenges as well as predictors of difficulty. In the latest installment of our Global Health lecture series, Dr. Lagasse gave us a great review on the unique uses of point of care ultrasound in a resource limited setting. Our R1 Diagnostics curriculum was continue by Dr. Gleimer who discussed the use of PFTs in the ED setting and Drs. Ham & Wright finished things up with an altered mental status CPC presentation. 

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Interpretation of Pulmonary Function Tests in the ED

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Interpretation of Pulmonary Function Tests in the ED

While formal pulmonary function testing is not often (if ever) performed in the ED, many patients with a history of COPD, asthma, CHF, sarcoidosis, etc, have had pulmonary function testing performed in the past.  Having an understanding of the underlying pathophysiology of these conditions, physiology of the lungs and respiration, and understanding of how the testing is performed is critical to being able to appropriately interpret the results of these test and apply the test results to our patients.

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Hypotension + Abdominal Pain = Ultrasound

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Hypotension + Abdominal Pain = Ultrasound

You are working an busy overnight shift at your rural community ER when a nurse comes to notify you of a new patient in the lobby - there are no open beds currently, but she thinks he looks ill.

You go out to evaluate the patient quickly - He is complaining of severe generalized abdominal pain that started a few hours ago and is worsening. He looks pale and slightly diaphoretic, has severe abdominal tenderness with peritonitis. Concerned, you wheel him back to your trauma bay...

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Grand Rounds Recap 1.31.18

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Grand Rounds Recap 1.31.18

In this week's grand rounds, Dr. Stolz discussed all things DVT and the modified two-point compression study for lower extremity clots. In our recurring EM-neuro combined conference, Dr. Stettler discussed the recent DAWN trial results, and how to incorporate CT perfusion studies into our acute ischemic stroke decision trees. In our Quarterly Sim, we discussed the management of the crashing patient from a house fire, and practiced our escharotomy skills. In our mock oral boards, we went through cases on STEMI, carbon monoxide exposure and limb ischemia. Finally, Dr. Lane discussed the workup of acute diarrhea in the adult population, and Dr. Shah went through a particularly unique toxidrome presentation in his R4 Case Follow Up. 

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It's Not "Just the Flu"

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It's Not "Just the Flu"

This past month has seen the appearance and peaking of seasonal influenza in the Northern Hemisphere.  This year, a particularly early strain of flu has been causing widespread illness across all 50 of the United States.  The start (or height) of any flu season is a good time to refresh our understanding of the influenza virus, prevention strategies, testing methods, and treatment modalities.  This year, however, we also sit exactly 100 years removed from the most deadly global pandemic ever seen by humanity.  Try your hand at some flu-based trivia and take a listen to the podcast below (or on iTunes).

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Grand Rounds Recap 1.24.18

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Grand Rounds Recap 1.24.18

This week's Grand Rounds started off with our monthly Morbidity and Mortality conference with Dr. Titone.  This was followed by a lecture on pediatric bloody diarrhea with Dr. Shan Modi.  Dr. Claire O'Brien then gave her Clinical Soap Box lecture on cost and waste within the healthcare system.  Dr. Kreitzer then gave an evidence based lecture on current research in sepsis and refractory septic shock, followed by our consultant of the month lecture with Dr. Anthony Blanchard from podiatry discussing foot wounds and osteomyelitis.

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Grand Rounds Recap 1.17.18

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Grand Rounds Recap 1.17.18

This week's Grand Rounds started out with another installment of our leadership curriculum led by Dr. Stettler, where we discussed how to identify and manage finance in leadership.  This was then followed by Dr. Makinen's small group session on thyroid diagnostics in the ED.  Drs. Gauger and Loftus then went head-to-head on a case of syncope, found to have a massive PE.  Dr. Miller then gave a great summary of current thoughts and future approaches to sepsis, followed by Dr. Murphy discussing post-ENT procedure bleeds in the ED.  Dr. Curry then finished off the conference with his "Mastering Minor Care" segment on epistaxis.   

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Interpretation of Thyroid Studies in the Emergency Department

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Interpretation of Thyroid Studies in the Emergency Department

Thyroid studies, often lying in the depths of any medical student differential, are an important tool in the Emergency Physician's toolkit, and knowing what to order when is a key part of using them wisely. This week, Dr. Makinen gives us a breakdown of thyroid pathology and testing.

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Grand Rounds Recap 1.10.18

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Grand Rounds Recap 1.10.18

Grand rounds this week started off with a review of the EMTALA law with Dr. Hinckley, as well as some case discussion.  This was followed by a presentation from our clinical pharmacists, PharmD's Nicole Harger and Madeline Stephens, on anti-epileptic medications and their uses, as well as an update on our medication supplies in the ED.  Drs. Murphy-Crews and Scanlon then presented their evidenced based algorithm for the management of STEMI, followed by our combined peds EM lecture with Dr. Kevin Overmann on the evaluation of the pale child and pediatric anemia.  This was followed by Dr. Ludmer's R4 case follow up/best of residency cases.  The day finished up with Dr. Sim Mand presenting her clinical diagnostics lecture on the assessment and management of the non-pregnant patient with abnormal uterine bleeding. 

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Grand Rounds Recap 1.3.17

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Grand Rounds Recap 1.3.17

The first grand rounds of 2018 started out with an R4 Simulation that highlighted the clinical presentation, diagnosis, and management of salicylate toxicity.  This was followed by a guest lecture by Dr. Richard Sears, who discussed the benefits of wellness and mindfulness, and how we can apply them in the workplace.  Dr. Hall then went over the utility and application of various labs used to evaluate patients with sickle cell disease who present in vaso-occlusive crisis.  We then finished the conference with a case based discussion on septic bursitis led by Dr. Mike Klaszky. 

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