Bug Juice Potpourri

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Bug Juice Potpourri

In this month's Journal Club, we covered several articles that looked at the use of antibiotics in the Emergency Department.  Does adding Trimethoprim-Sulfamethoxazole to Cephalexin increase the rates of clinical cure in uncomplicated cellulitis? For patients receiving Vancomycin in the ED, how many are appropriately dosed and how many receive a sufficient number of doses to hopefully limit the emergence of resistant bacteria?  Are patients receiving Vancomycin and Piperacillin-Tazobactam really at increased risk of acute kidney injury?

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Spinal Epidural Abscess

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Spinal Epidural Abscess

Spinal epidural abscess - what was once a 'white whale’ diagnosis in the Emergency Department, has, with the opiate epidemic and rise in IV drug use, become a consistent specter in our differential diagnoses. Potentially debilitating, potentially deadly, devilishly difficult to diagnose in it’s early stages; spinal epidural abscesses have become a persistent concern for patients presenting to the ED with back pain. Much like syphillis, lupus, and HIV, the response to the question of “could it be a spinal epidural abscess?” is usually “ughh, yeah I guess so.”  In this article, we will briefly cover the pathogenesis and presentation of spinal epidural abscessed and delve more deeply into the question of how best to treat these patients?  What are the triggers for surgical intervention? Are patient’s with neurologic deficits doomed to a life of persistent neurologic disability?

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Grand Rounds Recap 9.5.18

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Grand Rounds Recap 9.5.18

This weeks grand rounds started off with a discussion on the utility of the bougie in airway management by Dr. Carleton. This was followed by Dr. Kiser and Dr. Gensic who led us through a case-based discussion on complex laceration repairs encountered in the community ED setting. Dr. Neth then presented the evidence behind the use of epinephrine and mechanical CPR in out of hospital cardiac arrest. Next up was Dr. Soria who presented a case of Wernicke’s Encephalopathy with some learning pearls about this often under-diagnosed condition. Dr. Goel then masterfully answered the CPC challenge placed by Dr. Li to diagnose a rare case of ocular syphilis. Dr. Berger then finished the day with an overview of necrotizing fasciitis and the LRINEC score.

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QI/KT: Cardiac Arrest

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QI/KT: Cardiac Arrest

The first of a new series of posts with associated podcasts looking at the literature behind what we do every day in the ED with takeaways of tangible algorithms to guide every day practice. This month Drs Gauger and Harty lead us in a discussion of cardiac arrest, the drugs we use, the ultrasound we dabble with and the future interventions that could become standard of care.

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Cotton Fever

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Cotton Fever

When a patient with a history of recent IVDU presents with a complaint of fever, the mind of the provider should immediately focus on the numerous possible infectious complications that can arise.  Infectious endocarditis can lead to septic emboli spread to any organ system.  Pneumonia can result from aspiration or septic embolization. Cellulitis/abscess can obviously result from local injection.  But what about when a source of fever is not readily identifiable? When cultures are negative and the patient’s symptoms have resolved, what could have been the cause of their febrile illness?

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Grand Rounds Recap 8.29.18

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Grand Rounds Recap 8.29.18

This weeks grand rounds started off with a Morbidity and Mortality presentation by Dr. Baez including topics such as STEMI in LVH, pharmocologic cardioversion, and septic arthritis of the finger. This was followed by Dr. Freiermuth who gave us some pearls on the approach and management of sickle cell patients in the ED. Dr. Shaw then discussed some disturbing new health policy issues. Dr. Essell, a Heme/Onc attending at Jewish Hospital then walked us though GvHD, Acute Leukemia emergencies, and a fascinating new treatment option for blood cancers CAR-T. The day continued with a review of burn management by Dr. Spigner. Dr. Walsh then finished the day with an overview of carboxyhemoglobinemia and methemoglobinemia.

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Grand Rounds Recap 8.22.18

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Grand Rounds Recap 8.22.18

The week started off with our AirCare team discussing indications for procedures performed pre-hospital. The AirCare team continued by taking us through several cases in our quarterly AirCare M&M. We then got some oral boards practice with Drs. McDonough and LaFollette. The day finished with a simulation led by Dr. Hill covering patients who wish to leave AMA as well as the terrifying lengthening QTc.

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Annals of B-Pod Summer 2018 Issue!

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Annals of B-Pod Summer 2018 Issue!

Hot off the presses, be the first to take a gander at the Annals of B-Pod summer 2018 issue! From neurosyphilis to pneumomediastinum to life-threatening baclofen withdrawal, you'll find that it's not just the summer heat making you sweat as we recount tales of these "great imitators" - clinical conditions that may present perniciously or deceive providers with their nebulous constellation of symptoms. Read about all of these and more on the latest issue of Annals of B-Pod!

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Grand Rounds Recap 8.15.18

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Grand Rounds Recap 8.15.18

The week started off with a discussion on research and ways to get involved during residency. We then got a primer on early pregnancy ultrasound and ectopic pregnancy from Dr. Stolz. Our yearly directives series covered personal finance/loans as well as the job search and contract negotiation. Dr. Stettler then gave us some pearls on how to manage the agitated patient. This was followed by Dr. Plash who discussed the removal of GI foreign bodies. We then ended with a visiting lecturer, Michigan Program Director Dr. Laura Hopson, who covered bedside teaching tips and tricks.

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Annals of B-Pod: Baclofen Pump Failure

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Annals of B-Pod: Baclofen Pump Failure

Muscle relaxants see a wide variety of uses in the emergency department. From the treatment of sprains and strains to the management of spasticity in patients with upper motor neuron disease, agents like baclofen, cyclobenzaprine, and methocarbamol are well-established elements of an emergency physician’s armamentarium. With prolonged utilization, however, patients may develop dependence on these agents. Furthermore, this dependence may progress to potentially life-threatening withdrawal symptoms should the muscle relaxants be abruptly discontinued. In this article, Dr. Gottula walks us through the presentation and management of a patient suffering from a severe baclofen withdrawal following the failure of her intrathecal pump, including a discussion of the underlying pathophysiology and diagnostic considerations in the emergency department.

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Annals of B-Pod: Neurosyphilis

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Annals of B-Pod: Neurosyphilis

One of the fundamental axioms of medicine, passed down from generation of physicians to generation of physicians, “it could be syphilis” Perhaps no spirochete has garnered such infamy nor acrimony as Treponema pallidum. In this impeccably researched piece, Dr. Hall delves into a presentation of neurosyphilis, a devastating manifestation of the infection stemming from transmission of the bacterium into the central nervous system. Dr. Hall details the presenting symptoms, diagnostic approach, and emergent management of syphilis before delving into the various other forms this “great imitator” might take.

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Grand Rounds Recap 8.8.18

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Grand Rounds Recap 8.8.18

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.

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Annals of B-Pod: Spontaneous Pneumomediastinum

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Annals of B-Pod: Spontaneous Pneumomediastinum

Air. It’s generally considered a pretty good idea. A fundamental aspect of aerobic metabolism and an essential need for most organisms on earth, it’s safe to say that life without air for a human isn’t much of a life at all. But what happens when air starts making mischief? What happens when air shirks the restrictive confines of the alveoli and elects instead to explore the muscle and subcutaneous tissue, seeks to admire the heart and great vessels, opts to race unencumbered along fascial planes and aponeuroses - what do you have then?

Well, a pneumomediastinum for one. In his article, Dr. Skrobut does a breathtaking job of detailing the presentation of a young patient with spontaneous pneumomediastinum, delving into the diagnostic modalities of choice, its emergent management, and the longterm prognosis. His article also seeks to clear the air about more controversial topics, including the role of empiric antibiotics and the need for surgical intervention.

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