Grand Rounds Recap 5.22.19

Grand Rounds Recap 5.22.19

This week we welcomed Dr. Thurman, a UC alumnus, back to Cincinnati for a fantastic quick hit visual diagnosis lecture. This was followed by a review of the literature on pneumonia by Drs. Modi and Mand. Dr. Wolochatiuk reviewed chemical and electrical burns, and Dr. Lane and Lang reviewed the diagnosis and management of proctitis in their CPC. Dr. Humphries presented some fantastic cases of zebra diagnoses in the ED. Lastly, Dr. Soria concluded with her inquisitive thoughts from over the years.

Read More

Air Care Series: Man Meets Machine

Air Care Series: Man Meets Machine

In this edition of the Air Care series we take a look at the LVAD via post and podcast, introducing you to the meeting of man and machine. Adam Gottula, MD interviews Liz Powell, MD and Paige Barger, NP covering the spectrum of LVAD basics from common functions to life threatening complications.

Read More

Surrounded by Mysteries We Cannot Hope to Understand

Surrounded by Mysteries We Cannot Hope to Understand

I.C. Cordes submissions arise spontaneously whenever I have something on my mind.  Usually they are concrete lessons in airway management, but recently I have done a lot of airway training and that tank is a little dry.  Hence, this is another foray into metaphysics as I stumble toward the twilight and navigate Erikson’s 8th stage of psychosocial development.

Read More

US - Molar Pregnancy: Ultrasound of the Month

US - Molar Pregnancy: Ultrasound of the Month

Part of the power of bedside ultrasound is the ability to make a diagnosis within seconds of image acquisition. Join Dr. Golden as he takes us through a fascinating case of early pregnancy guided by POCUS in the emergency department and the unexpected finding that, while rare, can dramatically alter the patient’s ED course.

Read More

Grand Rounds Recap 5.8.19

Grand Rounds Recap 5.8.19

Welcome to another installment of the Grand Rounds Recap! We had an excellent series of lecturers that we are very excited to share with you. We started off the day with our visiting lecturer Dr. Noble who presented a some excellent pearls on how to better incorporate lung ultrasound in the management of our patients in the ED. Next up Dr. Mand and Dr. Lagasse went head to head in our clincopathologic case series. Dr. Lagasse nailed the diagnosis of Dengue hemorrhagic fever and Dr. Mand then educated us on how it can progress to shock. To follow came Dr. Pulvino who lead us through some small group cases on the utilization of the PERC criteria and Wells score in the evaluation of patient with a potential pullmonary embolism. Next was Dr. Connelly who presented on the evaluation and management of patients with conditions resulting from ascent to high altitudes. To wrap up the day Dr. Lipshaw demystified the pediatric rash patient.

Read More

Tidal Volume Strategies for those without ARDS

Tidal Volume Strategies for those without ARDS

 Invasive ventilation is one of the most frequently applied interventions utilized for critically ill patients.  However, as with all medical interventions, there are potential risks and harms which must be balanced with perceived benefit.  As our understanding of physiology grows, we have found more and more potential harms associated with invasive mechanical ventilation. This review of a recent article published in JAMA explores the impact of different tidal volume strategies for patients who do not have ARDS.

Read More

PERCs of the Wells Score

PERCs of the Wells Score

Pulmonary embolism (PE) is one of the big “can’t miss” diagnoses in the emergency department. Unfortunately, presenting symptoms are often vague, and definitive diagnostic testing is expensive and comes with risks of radiation and contrast to the patient. In order to avoid missing a PE while mitigating the risks associated with overtesting, some clinical decision tools have been created to aid in the diagnostic process. We will focus on two of these commonly used decision tools: the PERC rule and the WELLS score for PE.

Read More

Grand Rounds Recap 5.1.19

Grand Rounds Recap 5.1.19

We had an exciting Grand Rounds this week. We started off with our visiting lecturer, Dr. Jennifer Wiler, who gave us an excellent overview of the dollars and cents behind the care that we provide in the emergency department. Afterwards we practice some oral board style cases. Dr. Betz led a challenging triple patient encounter where we had to simultaneously manage a knee dislocation, aortic dissection with involvement of the right coronary artery, and pneumonia in the setting of HIV. Dr. Curry led a riveting case of preeclampsia where identifying the critical history of a recent delivery was critical to initiating the correct management. We wrapped up the day with a simulation led by Drs. Hill, LaFollette, and Lang on in-flight emergencies!

Read More

A Headache with Consequences - Temporal Arteritis

A Headache with Consequences - Temporal Arteritis

This will mark the third and final recap of the March 2019 asynchronous small group cases.  Feel free to take a look and listen back at Parts 1 and 2.  This post we’ll be covering the presentation fo a middle aged female with a headache.  The differential is broad and fraught with a number of life/limb/sight threatening diagnoses.  As with the previous recaps, we recorded a podcast where we walk through the presentation, initial work up and management.

Read More

Grand Rounds Recap 4.24.19

Grand Rounds Recap 4.24.19

This week’s grand rounds started off strong with Morbidity and Mortality led by Dr. Baez. She discussed a wide variety of topics including stress testing in the ED, precautions, hearing loss, aspiration, and tamponade. Dr. Randolph followed this up with an insightful discussion on high risk ED discharges. The Global Health Team then shared some of the fascinating cases they encountered overseas. Dr. Sabedra reflected on how much we learn from each other by giving a heartfelt talk on what she has learned from her fellow R4’s. We continued with Dr. Gawron reviewing the many cervical spine rules and how to properly apply them. To conclude, Drs. Skrobut and Roche went head to head in this weeks CPC. Who wins? Read on to find out.

Read More

Air Care Series: A Case of Massive Clot

Air Care Series: A Case of Massive Clot

Shan Modi, MD walks us through a critically ill patient with pulmonary embolism then breaks down the literature surrounding the management of Pulmonary Embolism both in the Emergency Department and Critical Care Transport Environment. We will cover fluid support, vasopressor usage, ventilatory management, vasodilators, ECMO and more!

Read More

The Return of Droperidol...

The Return of Droperidol...

Have you heard the news! Droperidol is back and available in the United States.  After a prolonged hiatus the medication has been picked up by a new manufacturer and may be finding its way to a hospital pharmacy near you.  Since it has been some time since the medication has been in common use, and since the memory of its effectiveness may be buoyed by a sense of nostalgia or otherwise viewed through rose colored glasses, now is as good a time as any to take a stroll through the literature and learn a bit more about the effectiveness and side effect profile of the medication.

Read More