Annals of B-Pod: Baclofen Pump Failure

Annals of B-Pod: Baclofen Pump Failure

Muscle relaxants see a wide variety of uses in the emergency department. From the treatment of sprains and strains to the management of spasticity in patients with upper motor neuron disease, agents like baclofen, cyclobenzaprine, and methocarbamol are well-established elements of an emergency physician’s armamentarium. With prolonged utilization, however, patients may develop dependence on these agents. Furthermore, this dependence may progress to potentially life-threatening withdrawal symptoms should the muscle relaxants be abruptly discontinued. In this article, Dr. Gottula walks us through the presentation and management of a patient suffering from a severe baclofen withdrawal following the failure of her intrathecal pump, including a discussion of the underlying pathophysiology and diagnostic considerations in the emergency department.

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Annals of B-Pod: Neurosyphilis

Annals of B-Pod: Neurosyphilis

One of the fundamental axioms of medicine, passed down from generation of physicians to generation of physicians, “it could be syphilis” Perhaps no spirochete has garnered such infamy nor acrimony as Treponema pallidum. In this impeccably researched piece, Dr. Hall delves into a presentation of neurosyphilis, a devastating manifestation of the infection stemming from transmission of the bacterium into the central nervous system. Dr. Hall details the presenting symptoms, diagnostic approach, and emergent management of syphilis before delving into the various other forms this “great imitator” might take.

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Grand Rounds Recap 8.8.18

Grand Rounds Recap 8.8.18

This week started with a discussion on how we can improve our documentation to maximize our level V billing. This was followed by a summary of practice changing literature over the last year, a discussion on how we deal with failure in the clinical setting, and a guide to the approach of the agitated pediatric patient. Finally, we broke into small groups to learn about ENT emergencies.

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Annals of B-Pod: Spontaneous Pneumomediastinum

Annals of B-Pod: Spontaneous Pneumomediastinum

Air. It’s generally considered a pretty good idea. A fundamental aspect of aerobic metabolism and an essential need for most organisms on earth, it’s safe to say that life without air for a human isn’t much of a life at all. But what happens when air starts making mischief? What happens when air shirks the restrictive confines of the alveoli and elects instead to explore the muscle and subcutaneous tissue, seeks to admire the heart and great vessels, opts to race unencumbered along fascial planes and aponeuroses - what do you have then?

Well, a pneumomediastinum for one. In his article, Dr. Skrobut does a breathtaking job of detailing the presentation of a young patient with spontaneous pneumomediastinum, delving into the diagnostic modalities of choice, its emergent management, and the longterm prognosis. His article also seeks to clear the air about more controversial topics, including the role of empiric antibiotics and the need for surgical intervention.

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Grand Rounds Recap 8.1.18

Grand Rounds Recap 8.1.18

Chock full of didactic pearls, this week EM/Sports Medicine physician Dr. Betz started us off with a number of can’t-miss orthopedic injuries. Drs. Baez and Owens led us through case follow ups of air embolism and a sick neonate in shock. To finish up, Wilderness Medicine’s own Drs Mel Otten and Conal Roche taught us about marine and snake envenomations and dive injuries.

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Grand Rounds Recap 7.25.18

Grand Rounds Recap 7.25.18

This week started with our monthly Morbidity and Mortality conference where we discussed posterior MIs, tough dissections and more tough cases. We then heard a debate on the use of D-Dimer in the diagnosis of aortic dissection. Finally, we were led through a simulation of a sick GI bleed requiring Minnesota tube placement, and we discussed optimal management of these challenging patients.

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Global Health: Case Series

Global Health: Case Series

The Global Health case series highlights interesting cases 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. Dr. Jarrell continues this year's case series with a case of a child who presents with a complication of a formerly common rash!

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The Shocked Intubation: Definitive Airway Sans Hypotension

The Shocked Intubation: Definitive Airway Sans Hypotension

Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation.  Yet few words together strike greater fear in the minds of savvy resuscitationists.  Not because we cannot deftly manage shock, or because we are anything but hardy intubators, but because the swiftest way to transform a living patient into a dying patient or a dying patient into a dead patient is to brazenly intubate someone who is in shock.  What are the root causes of endotracheal intubation's (ETI) hemodynamic effects and, most importantly, how do we circumnavigate them?  Read on to learn how to safely intubate the patient in shock…

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Grand Rounds Recap 7.11.18

Grand Rounds Recap 7.11.18

This week’s Grand Rounds started with a leadership session led by Dr. Stettler where we discussed the qualities of strong leaders and how we can use those qualities to implement change within our department and health system. Dr. Knight covered the management of concussions and spinal cord injuries in the emergency department. From there, Dr. LaFollette led us through a discussion of how to manage various ENT and ophthalmology complaints in the community setting.

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Grand Rounds Recap 7.4.18

Grand Rounds Recap 7.4.18

Let the new year begin! This year’s Grand Rounds kicked off with a series of topics covering why what we do matters, and that starts with how we as ED providers conduct ourselves. Dr. Palmer started us off with a discussion of teamwork, how to overcome difficult teamwork scenarios and overcome adverse encounters with integrity. Dr. Doerning gave some insights and lessons in analytics and a foray into datasets using ‘R’ and Dr. McDonough led the group in a talk and small group exercise in professionalism.

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The Last Gasp

The Last Gasp

It is undoubted that effective airway management is a critical link in the care of patients with both in-hospital cardiac arrest and out-of-hospital cardiac arrest.  But how exactly should one manage the airway?  What results in the best outcomes for our patients? Should we be aiming to intubate every patient? Or, are extraglottic devices as effective (or more effective)? What about the good old bag-valve mask?  In our most recent Journal Club we explored the evidence surrounding airway management in cardiac arrest, covering 3 high impact articles.  We also touch on an abstract presented at the 2018 SAEM Academic Assembly which should add significantly to the body of literature when it is published in full.  Take a listen to our recap podcast below and/or read on for the summaries and links to the articles.

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Grand Rounds Recap 6.27.18

Grand Rounds Recap 6.27.18

The final Grand Rounds for the 2017-2018 academic year opened with a fantastic morbidity and mortality conference given by Dr. Ludmer. Dr. Randolph then gave us his approach to the dyspneic and hypoxic patient. Thanks for following us through this enriching and amazing year of education!

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Air Care Orientation Case #4

Air Care Orientation Case #4

May brought the fourth case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack.  This month, a case of sepsis.  Should we just transfer the patient as quickly as possible, or are there other things we should do first?  Read on to find out!

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