Grand Rounds Recap 11.14.18

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Grand Rounds Recap 11.14.18

We had a great Grand Rounds line-up this week - Dr. Whitford started us off with a challenging case of altered mental status that took a variety of twists and turns highlighting the need for reassessment flexibility in your differential diagnosis in the critically ill patient. Next up was Dr. Koehler and Dr. Betz who led us through a case of septic arthritis which presented atypically as altered mental status. Dr. Edmunds then provided us with emergency presentations of pediatric vomiting. Lastly, we closed the day with Dr. Roblee’s excellent case-based discussion on the evaluation and management of hypertension in pregnancy.

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Air Care Series: Burns Management

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Air Care Series: Burns Management

Severely burned patients can be intimidating for even the most seasoned critical care transport providers. These patients often require aggressive resuscitation and multiple procedures in a relatively short period of time. It is often easy for providers to become overwhelmed, necessitating an algorithmic approach to the patient, similar to traumatically injured patients, is crucial. By advancing through the primary survey and stabilizing the patient while starting aggressive but goal directed crystalloid resuscitation, critical care transport providers can bring ICU level care to one of the sickest pre-hospital patient populations.

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Grand Rounds Recap 11.7.2018

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Grand Rounds Recap 11.7.2018

Enjoy the review of this week’s Grand Rounds! We began the morning with Dr. Minges giving us his pro-tips on how to identify cardiac tamponade with ultrasound. Following this, we learned about high-yield management pearls about Carotid Blowout Syndrome and SCIWORA from Dr. Scanlon and Dr. Baez respectively. We concluded the day with AirCare Grand Rounds, where we learned how to deal with refractory hypoxia, postpartum hemorrhage, and utilize the V-scan for ultrasound.

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Air Care Series: Balloon Tamponade of Variceal Hemorrhage

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Air Care Series: Balloon Tamponade of Variceal Hemorrhage

In HEMS, there are rare instances where ‘stay and play’ is the safest thing for the patient. Exsanguinating variceal bleed is one of those conditions. This week Dr. Whitford takes us step-by-step through the placement and confirmation of balloon tamponade placement (Minnesota Tube) for stabilization of these bleeds. We hope by reading this, it gives you another 6 months of this not happening on your next transport or ED shift...

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Grand Rounds Recap 10.31.18

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Grand Rounds Recap 10.31.18

We had a diverse and interesting set of topics for this week of Grand Rounds! Dr. Mehlman, a pediatric orthopedist, took us through high-yield, can’t miss orthopedics cases. Following this, we went through strategies in team-building and recruitment with Drs. Stettler, Fermann, and McDonough as part of our Leadership Curriculum. Dr. Jarrell then presented local data on our Naloxone Distribution program and opioid overdoses. We concluded the day with a lecture on hernia diagnosis and management by Dr. Leech, followed by a fantastic small group session on Wellness lead by Drs. Jarrell and Banning. Enjoy our summary of these high-yield topics!

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The Mighty Paper Clip

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The Mighty Paper Clip

You’re working in the ED on a busy Halloween evening. So far you have seen patient’s in all manner of costumes.. 2 Donald Trumps, 1 Santa Claus, a father-daughter pairing of Beast and Belle. Your next patient is dressed as Kylo Ren. He is a 16 yo M who was out trick or treating with some friends when they started to play fight with their lightsabers.  He was attempting to block a strike when his friends lightsaber bounced off his and hit him in the right eye.  He immediately had severe pain in the eye and face and noticed some loss of vision.  He went home and showed his parents who brought him to see you in the ED.

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Grand Rounds Recap 10.24.18

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Grand Rounds Recap 10.24.18

It was an exciting week of Grand Rounds where Dr. Colmer presented our monthly Morbidity and Mortality conference. We had a fantastic guest lecturer, Dr. Reuben Strayer (@emupdates), who discussed opioid abuse and airway management. Finally, our consultant of the month was Dr. Amy Makley who discussed blunt abdominal trauma. Take a look!

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Grand Rounds Recap 10.17.18

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Grand Rounds Recap 10.17.18

This week we started off with Drs. Gleimer and Koehler running through the new ‘early, often and subQ’ QI/KT protocol for Sickle Cell Disease. Dr. LaFollette then discuss the oft-ignored complaint of hemorrhoids and peri-anal abscesses. We got snapshots from resident attendees of ACEP and Dr. Continenza discussed a case of postpartum hemorrhage resuscitation.

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Grand Rounds Summary 10.10.18

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Grand Rounds Summary 10.10.18

From epi drips to peds fracture tips, it was an eventful Grand Rounds. We began with a debate on the utility and method of epinephrine during cardiac arrest. Dr. Murphy then discussed hemodialysis access complications followed by Dr. Palmer’s operations update. Dr. Shah led a discussion on the recognition and management of pediatric fractures. We concluded by covering a variety of other pediatric topics during the R3 small group session. Take a look!

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US - Diagnosing PE: Ultrasound of the Month

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US - Diagnosing PE: Ultrasound of the Month

PE is often a considered and easily risk-stratified diagnosis, however what about when you take away your definitive test of the CTPA? Dr. Ham examines the 60/60 sign and other ultrasonographic tests you can use to determine the acuity of right ventricular strain which is addition to the clinical and hemodynamic evaluation can help you triage additional strategies to traditional anticoagulation.

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A Weakness in the HEART?

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A Weakness in the HEART?

In this month’s Journal Club Recap we take a look at some recently published literature about common heart related complaints in the ED. First, we look at the now nearly ubiquitously used HEART pathway. In a US population, do the benefits of decreased health care utilization sustain themselves to a year out of an index visit? Then we turn our attention to atrial fibrillation with RVR. Does the utility infielder of ED medications, Magnesium, actually help with more rapid rate control? And, should the results of a consensus panel sway us to treat A fib with RVR as an outpatient?

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Minor Care Series: Fingertip Injuries

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Minor Care Series: Fingertip Injuries

Not all fingertip injuries are created equal. From a box cutter slice to a crush injury, your time and investment into these patients’ injuries varies quite significantly and we need to be ready to be expert at all options. Dr. Li guides us in a quick run down of the injury and repair types of fingertip injuries in this month’s Mastering Minor Care.

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Grand Rounds Recap 9.26.18

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Grand Rounds Recap 9.26.18

This weeks grand rounds started off with our Morbidity and Mortality conference led by Dr. Shaw who led us on an education expedition covering the use of REBOA, surgical vs. medical management in spontaneous miscarriage, ways we can improve our use of the electronic medical record, management of a persistent air leak in a patient with a chest tube, and the role of CT in CAP. Dr. Alwan then provided us an in-depth look at the often untold challenges of life as a refugee as well as the challenges we face in providing care for these patients. This was followed by Dr. Randolph who presented a case of an incredibly complicated patient with a pulmonary embolism to highlight the steps in management of a decompensating patient with a pulmonary embolism before you initiate thrombolysis. Next up was Dr. Gottula and Dr. Hinckley who went head to head with a challenging presentation of acute aortic dissection as part of our CPC lecture series. Dr. Leech then finished up the day with a case based discussion on the utility of the Kocher Criteria in the evaluation of child with an acutely painful hip.

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