The A Fib Chicken and Egg - III Recap

The A Fib Chicken and Egg - III Recap

This is the first in a series of 3 blog posts recapping our residency’s most recent asynchronous small group exercise.  For these posts, we’ll start with a case vignette and then highlight some key aspects of the presentation and cover some key learning points. You can also take a listen to the accompanying podcast for a slightly more in depth look at the case.

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Grand Rounds Recap 3.27.19

Grand Rounds Recap 3.27.19

Enjoy this week’s Grand Round’s Recap. Dr. Murphy started us off with a great Morbidity and Mortality conference with a variety of fascinating cases. Next, Dr. LaFollette taught us some pearls for HEENT emergencies if you are out in the community. Dr. Hunt took us through transfusion reactions and how to manage them, followed by Dr. Hall discussing the management pearls of Nonconvulsive Status Epilepticus. Next, Dr. Connelly taught us how we can incorporate alternative EKG leads into our practice, and Dr. Klaszky finished our day with a nuanced take of how to manage refractory septic shock. It was a jam packed day full of great learning!

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Telling Tall Tales: Dogma in Emergency Medicine

Telling Tall Tales: Dogma in Emergency Medicine

In our training and education as Emergency Medicine providers, we often come to accept certain practice patterns as fact. When these established “facts” come along with fantastical clinical claims (don’t give your corneal abrasion patients tetracaine, it’ll melt their corneas; don’t use lido with epi for digital blocks, their finger will fall off; don’t use beta-blockers in patients on cocaine, their BP will skyrocket due to unopposed alpha-effects), we should probably look to question their supporting evidence.

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Diagnostics: Alternative EKG Leads

Diagnostics: Alternative EKG Leads

Ever have a patient that looks more concerning than their EKG? Perhaps their ischemia is in that anatomically difficult to access right ventricle or even posterior. Join Dr. Connelly in looking at the utility of right sided, posterior and Lewis leads and bring something new to your next chest pain patient.

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Grand Rounds Recap 3.20.19

Grand Rounds Recap 3.20.19

Enjoy this week’s Grand Rounds Recap! Dr. Jordan Bonomo started us off with a fascinating talk on brain death, and how therapeutic hypothermia in the post-arrest patient can make this diagnosis more challenging. Next up, Dr. Harrison taught us some pearls on management of the bradycardic peri-arrest patient. Dr. Nagle shared with a us how to rescuscitate a patient with acute aortic dissection. Lastly, Dr. Summers talked to us about PRES and how to recognize and treat this rare disorder.

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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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