This week started with a discussion on how we can improve our documentation to maximize our level V billing. This was followed by a summary of practice changing literature over the last year, a discussion on how we deal with failure in the clinical setting, and a guide to the approach of the agitated pediatric patient. Finally, we broke into small groups to learn about ENT emergencies.
Read MoreChock full of didactic pearls, this week EM/Sports Medicine physician Dr. Betz started us off with a number of can’t-miss orthopedic injuries. Drs. Baez and Owens led us through case follow ups of air embolism and a sick neonate in shock. To finish up, Wilderness Medicine’s own Drs Mel Otten and Conal Roche taught us about marine and snake envenomations and dive injuries.
Read MoreThis week started with our monthly Morbidity and Mortality conference where we discussed posterior MIs, tough dissections and more tough cases. We then heard a debate on the use of D-Dimer in the diagnosis of aortic dissection. Finally, we were led through a simulation of a sick GI bleed requiring Minnesota tube placement, and we discussed optimal management of these challenging patients.
Read MoreThis week’s Grand Rounds started with a leadership session led by Dr. Stettler where we discussed the qualities of strong leaders and how we can use those qualities to implement change within our department and health system. Dr. Knight covered the management of concussions and spinal cord injuries in the emergency department. From there, Dr. LaFollette led us through a discussion of how to manage various ENT and ophthalmology complaints in the community setting.
Read MoreLet the new year begin! This year’s Grand Rounds kicked off with a series of topics covering why what we do matters, and that starts with how we as ED providers conduct ourselves. Dr. Palmer started us off with a discussion of teamwork, how to overcome difficult teamwork scenarios and overcome adverse encounters with integrity. Dr. Doerning gave some insights and lessons in analytics and a foray into datasets using ‘R’ and Dr. McDonough led the group in a talk and small group exercise in professionalism.
Read MoreIt 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.
Read MoreThe 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!
Read MoreThis 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.
Read MoreIn 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.
Read MoreThis 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.
Read MoreDr. Nicholas Jensen uses a dynamic video walk-through to discuss the history and data of the evolving view of the diagnostic utility of BNP in the presentation of the acutely dyspneic patient. Learn why BNP has gone from a standard diagnostic test to another test we that deserves a second thought of its utility.
Read MoreThis 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.
Read MoreQ: 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?
Read MoreThis 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!
Read MoreYou’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?
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.
