US - Pregnancy The LABUR protocol: Ultrasound of the Month

US - Pregnancy The LABUR protocol: Ultrasound of the Month

Your pregnant patient gets rushed in uncomfortable and just shying of pushing but you have a few minutes to panic. Why panic when you can grab a probe and get some information about your impending delivery? Dr. Bernardoni guides us through the LABUR exam and the finer points of the term OB POCUS.

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Grand Rounds Recap 3.13.19

Grand Rounds Recap 3.13.19

This week’s Grand Rounds began with a practical discussion of the CBC and differential by Dr. Hassani. Dr. Hughes and Thompson led a fantastic CPC on a case of myxedema coma, and Dr. Whitford discussed CT over-utilization in the emergency department. We finished the day with our pediatrics colleagues who walked us through anxiety-provoking cases of aortic coarctation, bacterial tracheitis, and neonatal jaundice. Check it out!

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Grand Rounds Recap 3.6.19

Grand Rounds Recap 3.6.19

From surgical airways to the undifferentiated shock patient, this week’s Grand Rounds was packed full of clinical pearls. Dr. Carleton started with a discussion of a tachycardia-inducing failed airway requiring cricothyrotomy. Drs. Jensen and Makinen presented a very detailed review of the literature and their proposed algorithm on infective endocarditis. Dr. Harty reviews a fascinating case of cecal volvulus that was identified early with the aid of a RUSH exam, while Dr. Liebman walked us through an approach to the patient with inhalation injuries. Finally, Dr. Roblee led an excellent review of SBP. The discussion was full of information you might use on your next shift!

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The CBC and the Man Behind the Curtain

The CBC and the Man Behind the Curtain

It’s been called “the refuge of the intellectually destitute (physician)” by Amal Muttu. The CBC is a much maligned test that is nevertheless one of the the most frequently ordered diagnostic tests in the ED. To truly know how to interpret this test, one must understand its individual components, the possible causes of variations from normal for those components, and how it integrates into the clinical presentation of the patient. Also, it can’t help but to know and understand some of the historical background…

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Annals of B-Pod: Dural Venous Sinus Thrombosis

Annals of B-Pod: Dural Venous Sinus Thrombosis

The headache is the simplest and most complex we see on a daily basis in the ED, but it is important to consider, on both ends, how the coagulation cascade can go awry and be a causative source. Dr. Gawron walks us through a patient presenting with an unprovoked and rather discourteous dural venous sinus thrombosis, its natural history, and appropriate emergent evaluation and management.

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Annals of B-Pod: Neurogenic Shock

Annals of B-Pod: Neurogenic Shock

Spinal cord injuries are nothing to shake your head at, though. As Dr. Jensen eloquently dissects in his review of neurogenic shock, emergency physicians can play a tremendous role in the ultimate outcomes of patients with vasodilatory shock secondary with the prompt recognition and appropriate management of spinal cord pathology.

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Pneumonia Alphabet Soup

Pneumonia Alphabet Soup

Pneumonia. It’s one of the first conditions we learn to diagnose as medical students. It was probably the cause of the first really sick, septic geriatric patient you saw in residency. Conversely you have also probably sent a fair share of patient’s home with an outpatient course of antibiotics and PCP follow-up.  While determining the appropriate treatment and disposition for patients on the extreme ends of illness severity is quite straight forward; that pesky majority in the middle can be a conundrum at times. Who can go home? Who needs broad spectrum? Who needs step-down? Over the last two decades there has been a smorgasbord of pneumonia related acronyms used in clinical practice to predict severity, guide therapeutics and recommend disposition. During our most recent resident Journal Club, we took a look at a handful of the more familiar acronyms as well as some new ones coming down the pipeline.

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Annals of B-Pod: Osmotic Demyelination Syndrome

Annals of B-Pod: Osmotic Demyelination Syndrome

It is said that that the relatively high salt content of human serum and cerebrospinal fluid stems from our ancestral ties to the sea, that we carry a bit of the ocean around inside of us as a legacy, an homage to the brave evolutionary progenitor that first crawled out of the water and onto land. Unfortunately, our bodies must work hard to maintain that hypertonicity. Small fluctuations in our serum and CSF sodium content can lead to significant swelling or, more devastatingly, pronounced shrinking. Dr. Frederick’s fabulous article deftly details the clinical entity known as osmotic demyelination syndrome. Soak up the presenting features, clinical management, and dire prognosis of this much feared but rarely seen pathology.

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Air Care Series: Sepsis Update

Air Care Series: Sepsis Update

Katherine Connelly, MD reviews the literature surrounding the definition and management of sepsis both in the Emergency Department and Critical Care Transport Environment. We will cover pressor usage, as well as appropriate antibiotic coverage and if there is any role for steroids (for now…)

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Grand Rounds Recap 2.20.19

Grand Rounds Recap 2.20.19

This week’s grand rounds started with Dr. Colmer reviewing some fascinating cases in this months Morbidity and Mortality. We then split up into groups and did the quarterly sim focusing on informed consent led by Drs. LaFollette and Lang. This was followed by some challenging oral boards cases chosen by Drs. McDonough and Hill. Look forward to next week!

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Global Health Case Series: “Global Worming”

Global Health Case Series: “Global Worming”

The Global Health case series highlights interesting cases that residents experienced while practicing abroad and takes a dive into how to identify the pathology that is crucial know to care for patients both abroad and returning. Although Dr. Owens did not participate in the care of the patients described in these cases, she expertly tackles a disease that has received a lot of media attention.

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Grand Rounds Recap 2/13/19

Grand Rounds Recap 2/13/19

This week, we started Grand Rounds with ED-critical care research brought to us by UC Alumnus Dr. Brian Fuller. He discusses ventilator management in the ED and how ED sedation may affect patient outcomes. Dr. Harrison then presented an overview and common utilization errors of ED observation from his year as a Resident Assistant Medical Director, followed by Dr. McKee’s case of inhalational chlorine exposure. Dr. Alwan discussed updates to the less than 60 day fever protocol at CCHMC and Dr. Zozula walked through the dispatcher assistance protocols to give us an idea of what happens before they enter the ED doors.

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Grand Rounds Recap 2/6/19

Grand Rounds Recap 2/6/19

It was an exciting week of Grand Rounds! We had the honor of hearing from legendary UCEM graduate Dr. Susan Stern who was the Dr. Gibler Visiting Professor. She discussed hemorrhage in trauma and the changing landscape of leadership in medicine. This was followed by operations updates with Dr. Palmer, and Dr. Laurence discussed AIDS-defining illnesses in her clinical knowledge lecture. The day concluded with a review of some Air Care cases. Check it out!

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Grand Rounds Recap 1.30.19

Grand Rounds Recap 1.30.19

Welcome to another grand rounds recap! This week Dr. Isaac Shaw started us out with the monthly Morbidity and Mortality. Dr. Stolz then dove into some ultrasound QA, covering topics such as knee arthrocentesis and early pregnancy ultrasound. Dr. Murphy followed this up by discussing the science of motivation and how we can use this in the Emergency Department setting. This was followed up with Drs. Modi and Kircher who went head to head in this months CPC on endocarditis. Dr. Irankunda finished up the day with an excellent talk on the retrograde urethrogram. See you next week!

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