The Last Gasp

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The Last Gasp

It is undoubted that effective airway management is a critical link in the care of patients with both in-hospital cardiac arrest and out-of-hospital cardiac arrest.  But how exactly should one manage the airway?  What results in the best outcomes for our patients? Should we be aiming to intubate every patient? Or, are extraglottic devices as effective (or more effective)? What about the good old bag-valve mask?  In our most recent Journal Club we explored the evidence surrounding airway management in cardiac arrest, covering 3 high impact articles.  We also touch on an abstract presented at the 2018 SAEM Academic Assembly which should add significantly to the body of literature when it is published in full.  Take a listen to our recap podcast below and/or read on for the summaries and links to the articles.

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Grand Rounds Recap 6.27.18

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Grand Rounds Recap 6.27.18

The final Grand Rounds for the 2017-2018 academic year opened with a fantastic morbidity and mortality conference given by Dr. Ludmer. Dr. Randolph then gave us his approach to the dyspneic and hypoxic patient. Thanks for following us through this enriching and amazing year of education!

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Grand Rounds Recap 6.20.18

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Grand Rounds Recap 6.20.18

This academic year’s penultimate Grand Rounds started with Guest Faculty Lecturer Dr. Richard Levitan lecturing on airway tips, tricks, and trouble shooting. Drs. Harrison, Sabedra, and Summers then led small group sessions focused on unique applications of ultrasound. Dr. Hughes discussed TB management in the ED and Dr. Thompson closed out Grand Rounds with pearls on patient management.

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Grand Rounds Recap 6.13.18

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Grand Rounds Recap 6.13.18

In this week’s Grand Rounds, Dr. Polsinelli started us off with the diagnosis and management of aortoenteric fistula. We then discussed burnout and failure in our wellness curriculum in a small group setting, and heard from our colleagues in pharmacy about high-dose insulin therapy for calcium channel and beta blocker overdose. Dr. Roche led us in our Mastering Minor Care curriculum with a discussion of all things arthrocentesis, and we closed with a great combined PEM/EM simulation session and oral boards practice.

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Grand Rounds Recap 6.6.18

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Grand Rounds Recap 6.6.18

This week we were led through the evaluation and management of the difficult pediatric airway with Dr. Carleton in our quarterly airway grand rounds, and discussed cranial nerve abnormalities with Dr. Neel in our recurring EM-neuro combined conference. Dr. Jarrell presented an interesting case of a child with a cough and weight loss, and Dr. Jensen walked us through the clinical utility of BNP. Finally, Dr. Miller presented an interesting case of a patient with multisystem organ failure and cecum perforation. 

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Grand Rounds Recap 5.30.18

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Grand Rounds Recap 5.30.18

This week’s Grand Rounds started with Dr. Gorder’s expertly delivered Morbidity and Mortality lecture. Dr. Gottula then went over drugs of abuse, including the gabapentinoids. Dr. Shaw then talked about a case of sympathetic acute crashing pulmonary edema (SCAPE). Finally, Dr. Edmunds spoke about pediatric renal emergencies.

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Whole Blood - More than the Sum of Its Components?

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Whole Blood - More than the Sum of Its Components?

Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?  

A: If they've lost blood, give them blood.  

It's never quite that simple though right?  For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components.  Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients.  Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy.  If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?

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Grand Rounds Recap 5.23.18

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Grand Rounds Recap 5.23.18

This week’s Grand Rounds opened with Dr. Koehler leading small group discussions on the applications and limitations of VBGs. Dr. Bonomo expertly identified the correct test of choice and diagnosis in Dr. Spigner’s CPC. Dr. Soria then gave an interesting talk on the history behind naloxone as well as common uses. Finally, the Air Care team led a great hands-on procedure workshop!

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What's in a Blood Gas? VBG vs ABG

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What's in a Blood Gas? VBG vs ABG

You’re deep into a busy shift. Pushing yourself to see more volume towards the end of the year, you find yourself actively managing 8 patients.  You have 2 patients with difficulty breathing you believe have COPD exacerbations and 1 patient with a history of T1DM who has a critical high finger stick blood sugar and ketones in their urine.  You send VBGs as part of the work up for all these patients finding hypercarbia for the patients who have COPD exacerbations and a significant metabolic acidosis in the patient with T1DM confirming your diagnosis of DKA. You are in the process of admitting these patients when you face questions from your colleagues in-house as to why you didn’t perform an ABG on these patients?

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Grand Rounds Recap 5.9.18

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Grand Rounds Recap 5.9.18

This week Drs. Harty & Gauger walked us through the literature surrounding the care of the patient in cardiac arrest as part of their Quality Improvement & Knowledge Translation project. Dr. Kristiana Kaufmann, a visiting professor from Wayne State, provided us a look at Global Health opportunities. Our Quarterly Simulation session, lead by Dr. Bryant, was a case of a 15 year old with new onset SOB and polyarthralgias. Lastly Drs. Stettler & LaFollette provided us with mock oral boards cases.

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Grand Rounds Recap 4.25.18

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Grand Rounds Recap 4.25.18

This week’s Grand Rounds was kicked off with our W. Brian Gibler visiting professor series with Dr. Ali Raja M.D., MBA, MPH, and Vice Chair of Emergency Medicine at Massachusetts General Hospital. He gave us his insights on how to help move our specialty towards evidence based practice, as well as his tips on leadership within the context of academic emergency medicine. This was followed by our monthly Morbidity and Mortality Conference with Dr. Titone. Dr. Shah then gave his R4 Clinical Soap Box on the utility of ultrasound in cardiac arrest, and the conference finished with Dr. Whitford giving his R3 Taming the SRU case follow up.

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Rhogam Redux

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Rhogam Redux

Hemolytic Disease of the Fetus and Newborn (HDFN) is an alloimmune disease which develops in a fetus when a women’s immune system is sensitized, developing antibodies which cross the placenta and attack fetal RBCs. 

While there is a spectrum of the disease, in severe cases the fetus can ultimately develop hydrops fetalis which is often fatal.

As Emergency Physician’s we are classically taught that we can help to prevent HDFN by recognizing sensitizing events in Rh-negative women and subsequently providing RhoGAM. But which patients really need RhoGAM? The evidence seems to be lacking and recommendations are often inconsistent.

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Grand Rounds Recap 4.18.18

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Grand Rounds Recap 4.18.18

This week we got a refreshing look at soft tissue ultrasound from our US guru Dr. Stolz. We then moved to the opposite end of modern imaging with the rarely indicated but intermittently very useful KUB by Dr. Skrobut. Drs Kiser and Ventura battled it out in a CPC case of pyloric stenosis then the R4s ran a simulation and small group on global health pathologies.

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