Grand Rounds Summary 10.10.18

Grand Rounds Summary 10.10.18

From epi drips to peds fracture tips, it was an eventful Grand Rounds. We began with a debate on the utility and method of epinephrine during cardiac arrest. Dr. Murphy then discussed hemodialysis access complications followed by Dr. Palmer’s operations update. Dr. Shah led a discussion on the recognition and management of pediatric fractures. We concluded by covering a variety of other pediatric topics during the R3 small group session. Take a look!

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October US Case of the Month - Multi-organ US for Diagnosing PE

October US Case of the Month - Multi-organ US for Diagnosing PE

PE is often a considered and easily risk-stratified diagnosis, however what about when you take away your definitive test of the CTPA? Dr. Ham examines the 60/60 sign and other ultrasonographic tests you can use to determine the acuity of right ventricular strain which is addition to the clinical and hemodynamic evaluation can help you triage additional strategies to traditional anticoagulation.

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A Weakness in the HEART?

A Weakness in the HEART?

In this month’s Journal Club Recap we take a look at some recently published literature about common heart related complaints in the ED. First, we look at the now nearly ubiquitously used HEART pathway. In a US population, do the benefits of decreased health care utilization sustain themselves to a year out of an index visit? Then we turn our attention to atrial fibrillation with RVR. Does the utility infielder of ED medications, Magnesium, actually help with more rapid rate control? And, should the results of a consensus panel sway us to treat A fib with RVR as an outpatient?

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Minor Care Series: Fingertip Injuries

Minor Care Series: Fingertip Injuries

Not all fingertip injuries are created equal. From a box cutter slice to a crush injury, your time and investment into these patients’ injuries varies quite significantly and we need to be ready to be expert at all options. Dr. Li guides us in a quick run down of the injury and repair types of fingertip injuries in this month’s Mastering Minor Care.

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Grand Rounds Recap 9.26.18

Grand Rounds Recap 9.26.18

This weeks grand rounds started off with our Morbidity and Mortality conference led by Dr. Shaw who led us on an education expedition covering the use of REBOA, surgical vs. medical management in spontaneous miscarriage, ways we can improve our use of the electronic medical record, management of a persistent air leak in a patient with a chest tube, and the role of CT in CAP. Dr. Alwan then provided us an in-depth look at the often untold challenges of life as a refugee as well as the challenges we face in providing care for these patients. This was followed by Dr. Randolph who presented a case of an incredibly complicated patient with a pulmonary embolism to highlight the steps in management of a decompensating patient with a pulmonary embolism before you initiate thrombolysis. Next up was Dr. Gottula and Dr. Hinckley who went head to head with a challenging presentation of acute aortic dissection as part of our CPC lecture series. Dr. Leech then finished up the day with a case based discussion on the utility of the Kocher Criteria in the evaluation of child with an acutely painful hip.

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Air Care Series: Cardiogenic Shock

Air Care Series: Cardiogenic Shock

Cardiogenic shock presents many challenges in both the transport environment and hospital setting. We aim to review the current state of evidence pertaining to the medical management in the critical care transport environment.

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Grand Rounds Recap 9.19.18

Grand Rounds Recap 9.19.18

This weeks grand rounds started off with our combined Emergency Medicine and Neurology conference where Dr. Walsh provided us a summary of the current evidence surrounding ICH expansion and reversal of Warfarin and DOACs. This was followed by Dr. Summers who provided suggestions on how we can be more efficient providers in the ED. Dr. Irankunda then presented on the often missed diagnosis of abdominal compartment syndrome. Next up was Dr. Lang who summarized the current evidence for the various available modalities commonly used in treating back pain. Dr. Golden then finished the day with a couple of cases highlighting the challenges in managing the critically ill patient who presents with penetrating neck injuries.

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Grand Rounds Recap 9.12.18

Grand Rounds Recap 9.12.18

This week of grand rounds began with an evidence based algorithm for COPD management in the ED with Drs. Lane and Hall. Dr. Faryar then led us through a discussion on various common hand injuries. Dr. Fermann guided us through the management of a feared patient presentation: patients with atrial fibrillation and heart failure. The day continued with Dr. Banning’s Taming the SRU lecture about a case she had of a seizing pregnant patient. Dr. Frederick then gave us an overview of toxic alcohols. The day ended with a pediatric trauma simulation and several pediatric oral boards cases.

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Bug Juice Potpourri

Bug Juice Potpourri

In this month's Journal Club, we covered several articles that looked at the use of antibiotics in the Emergency Department.  Does adding Trimethoprim-Sulfamethoxazole to Cephalexin increase the rates of clinical cure in uncomplicated cellulitis? For patients receiving Vancomycin in the ED, how many are appropriately dosed and how many receive a sufficient number of doses to hopefully limit the emergence of resistant bacteria?  Are patients receiving Vancomycin and Piperacillin-Tazobactam really at increased risk of acute kidney injury?

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Spinal Epidural Abscess

Spinal Epidural Abscess

Spinal epidural abscess - what was once a 'white whale’ diagnosis in the Emergency Department, has, with the opiate epidemic and rise in IV drug use, become a consistent specter in our differential diagnoses. Potentially debilitating, potentially deadly, devilishly difficult to diagnose in it’s early stages; spinal epidural abscesses have become a persistent concern for patients presenting to the ED with back pain. Much like syphillis, lupus, and HIV, the response to the question of “could it be a spinal epidural abscess?” is usually “ughh, yeah I guess so.”  In this article, we will briefly cover the pathogenesis and presentation of spinal epidural abscessed and delve more deeply into the question of how best to treat these patients?  What are the triggers for surgical intervention? Are patient’s with neurologic deficits doomed to a life of persistent neurologic disability?

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Grand Rounds Recap 9.5.18

Grand Rounds Recap 9.5.18

This weeks grand rounds started off with a discussion on the utility of the bougie in airway management by Dr. Carleton. This was followed by Dr. Kiser and Dr. Gensic who led us through a case-based discussion on complex laceration repairs encountered in the community ED setting. Dr. Neth then presented the evidence behind the use of epinephrine and mechanical CPR in out of hospital cardiac arrest. Next up was Dr. Soria who presented a case of Wernicke’s Encephalopathy with some learning pearls about this often under-diagnosed condition. Dr. Goel then masterfully answered the CPC challenge placed by Dr. Li to diagnose a rare case of ocular syphilis. Dr. Berger then finished the day with an overview of necrotizing fasciitis and the LRINEC score.

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