Is a Cuff Enough?

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Is a Cuff Enough?

Sepsis is a leading cause of mortality for hospitalized patient’s both worldwide and in the United States.  The surviving sepsis guidelines weakly recommend invasive arterial blood pressure monitoring (IABP) over noninvasive blood pressure monitoring (NIBP) with a blood pressure cuff supported by low quality evidence.(1) Data comparing the accuracy between IABP and NIBP measurements are limited. The largest analysis of 736 critically ill patients found a mean difference of 1 mmHg which was not statistically significant, however, there was only one measurement recorded per patient.(2) Arterial lines have several drawbacks compared with non-invasive methods such as: training requirements for caregivers, potential for pain and increased pain medications, limitation of participation in physical therapy, risk of digital ischemia, and risk of iatrogenic infection.(3) In this journal club recap, we analyze an article looking at the relationship between invasive arterial line blood pressure readings and non-invasive cuff measurements.

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Approach to Hernias in the ED

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Approach to Hernias in the ED

A hernia is described as, “the abnormal protrusion of abdominal contents through a defect involving the normal confines of the abdominal compartments” (9). It often involves a portion of the intestine protruding through a weak point of the abdominal wall. The location and size of the hernia often determines the symptoms and complications that a patient will present with.

There are several risk factors that make developing a hernia more likely. Older patients and those who have had prior abdominal surgery may have weaker abdominal muscles or connective tissue which would make it easier for a hernia to develop. In addition, if there is increased abdominal pressure, such as patients with obesity, or those who participate frequently in weightlifting, this is another factor that may put someone at a higher risk of developing a hernia. Finally, those with poor wound healing, such as people who smoke often or patients with diabetes, may be at risk for incisional hernias. (6)

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Grand Rounds Recap 4.10.24

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Grand Rounds Recap 4.10.24

An excellent Wednesday here in Cincinnati! We started out the day with our ultrasound grand rounds where ultrasound fellow Dr. Broadstock took us through an interactive lecture on advanced cardiac ultrasound. This was followed by a lecture by faculty member Dr. Irankunda who discussed the importance of names and embracing individuality. Finally, we ended the day with a combined session with our pediatric colleagues where we covered pediatric procedures, foreign body aspiration, and a neonatal potpouri. We can’t wait for next week!

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Grand Rounds Recap 3.27.24

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Grand Rounds Recap 3.27.24

We had an excellent Grand Rounds this week! Dr. Yates led our monthly Morbidity & Mortality Conference discussing pathology ranging from Dabigatran overdose to acute limb ischemia. We had an exciting CPC with hypomagnesemia presenting as new onset psychosis with Drs. Joshi & Lang. Finally, Dr. Gallen led a lecture and small group discussion on tracheostomies and their complications.

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Grand Rounds Recap 3.20.24

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Grand Rounds Recap 3.20.24

We had an exciting Grand Rounds this week! Dr. Ben Bassin, a UCEM alum and our visiting lecturer from the University of Michigan, started off strong discussing innovation in emergency care delivery. He discussed modeling and design of modern emergency departments and our upcoming Flex ICU. Dr. Grisoli then shared an exciting resuscitation of a profoundly hypothermic cardiac arrest. We split off into small groups for simulation and oral boards covering tuberculosis, meningitis and the RV spiral of death.

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'Roids to the Rescue?

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'Roids to the Rescue?

Can the addition of high-dose methylprednisolone to the treatment of out-of-hospital cardiac arrest make a meaningful difference? In this post-hoc analysis of a placebo-controlled randomized control trial comparing high-dose methylprednisolone versus placebo in out-of-hospital cardiac arrest (OHCA), the authors aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients.

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Diagnostics and Therapeutics: Tricks of the Trach

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Diagnostics and Therapeutics: Tricks of the Trach

Successful airway management is one of the cornerstones of every emergency medicine physician’s toolkit, and tracheostomies can often fall under that category of “difficult” or “scary”. In this post, we aim to familiarize learners with the anatomy of the trach airway and basics of trach tubes as well as teach management and troubleshooting of various complications of tracheostomies.

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Grand Rounds Recap 03.13.24

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Grand Rounds Recap 03.13.24

Another great week of Grand Rounds! We started with optimizing our wet reads on MSK xrays then moved into a victorious CPC win in the diagnosis of giant cell artertitis with a patient presenting with CN VI palsy and diplopia. We then discussed the tips and tricks for hernia reduction before hearing a moving story of a harrowing AirCare transport for ECMO cannulation. We moved into R3 small groups covering obstetrics and labor from mother to newborn and finished off with our pediatrics team visiting to discuss emergent cardiac conditions.

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SQuID Protocol for DKA: Impact on ED Length-of-Stay

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SQuID Protocol for DKA: Impact on ED Length-of-Stay

With the advent of fast-acting subcutaneous insulin analogs over the past 20 years, multiple studies have demonstrated that subcutaneous insulin protocols for treatment for treatment of mild-to-moderate severity DKA are safe and cost-effective when compared to intravenous insulin infusion protocols in non-ICU settings. In the context of increasing ED and hospital crowding as well as limited ICU availability, this study aimed to evaluate the impact of a subcutaneous insulin (SQuID) protocol in the treatment of DKA on emergency department length-of-stay (EDLOS) and ICU admissions

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Consultant Corner: Acute Management of the Dislocated Knee

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Consultant Corner: Acute Management of the Dislocated Knee

A patient presents with severe knee and leg pain after an MVC and you are worried about a possible knee dislocation, but don’t know how to evaluate them thoroughly… Join us for a special consultant edition of TTSRU - Dr Sean Catlett, a PGY-4 orthopedic surgery resident and Dr Sarah Moulds, a PGY-3 EM resident to discuss a full approach to the knee exam and management of the dislocated knee.

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Grand Rounds Recap 3.6.24

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Grand Rounds Recap 3.6.24

We had another exciting week of Grand Rounds! We covered topics including our new hypoglycemia protocol with Drs. Beyde and Wolski to traumatic cardiac tamponade with Dr. Glenn to syncope roles with Dr. Kotei. We enjoyed a visiting lecture from our Ohio ACEP team talking about the role of ACEP in residency and beyond. We finished strong with a lecture from our program director Dr. McDonough talking about her take on wellness in residency!

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Grand Rounds Recap 2.14.24

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Grand Rounds Recap 2.14.24

Join us as we recap a very special week of Grand Rounds here at UCEM! We started off with Dr. David Wright, visiting us from Emory University, to discuss the very latest in ICH management and also share his pearls for developing into leaders in our field. Next, we are joined by Dr. Cheetham, a PEM attending and EMS fellow, who reminds us the importance of EMS handoffs and even offers ways we can improve the safety of our patients. Dr. Martella shares how his previous time spent working in fast food industry helped shape him into the dedicated and compassionate physician he is today. Followed by Dr. Lewis educating each of us on how to better recognize and manage acute-onset pulmonary edema in the crashing patient. Lastly, our PEM colleagues from CCHMC stop by to help us better diagnose and manage a child presenting to ED with a limp. This week certainly highlighted the collaborative nature of our speciality and we are beyond grateful for all our colleagues near & far that help make us into better providers!

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Grand Rounds Recap 2.7.24

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Grand Rounds Recap 2.7.24

Join us we recap another week of Grand Rounds. We start off with a CPC case, where Dr. Rodriguez challenges Dr. Benoit to a case involving a young child with recurrent syncopal episodes. Next up, Dr. Knudsen-Robbins teaches us all the tips/tricks to performing LPs in the ED. If you ever felt nervous about an pediatric airway, our airway expert, Dr. Carleton, walks us through all the nuances of a pediatric intubation. Meanwhile, Dr. Milligan reflects on her four years as a resident and shares her insight about making the hard decisions during training. One of our very own SRU tamers, Dr. Davis, teaches us how to expertly manage symptomatic bradycardia. Lastly, Drs. Broadstock and Ramachandran help us add nerve blocks to our growing toolbox used for treating acute pain in the ED.

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