Falling Out - Syncope Evaluation in the Emergency Department

Falling Out - Syncope Evaluation in the Emergency Department

Syncope is a common presenting complaint to the emergency department. Estimates suggest that 1- 3 percent of ED visits are for syncope.(1) While the large majority of these episodes are often benign, they can suggest underlying life-threatening etiologies such as arrhythmias, pulmonary embolism, and stroke. The disposition of these patients can represent a difficult quandary at times. In fact, emergency physicians are only able to establish a clear underlying diagnosis in approximately 50% of syncope patients after obtaining an HPI, physical exam and ECG. (2

Should these patients be observed in the ED? And, if so, for how long? Should they be admitted to the hospital for further workup and observation? Should they instead be discharged home with close follow-up? 

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Grand Rounds Recap 9.18.19

Grand Rounds Recap 9.18.19

This was a great week of Grand Rounds with a number of interdisciplinary presentations. The week started off with Dr. Neel presenting about common neurologic complaints in the ED in our first EM-Neurology combined lecture for the year. Dr. Jarrell then presented her R4 Case Follow Up lecture on a case of blunt pancreatic injury in non-accidental trauma. Dr. Wyrick, from the Department of Orthopedics, talked about his experiences on his global health trip to Tanzania. Finally, the week wrapped up with Drs. Iparraguirre, Jensen, and Lane leading small group workshops on orthopedic injuries.

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Grand Rounds Recap 9.11.19

Grand Rounds Recap 9.11.19

Drs. Winslow and Habib started the Grand Rounds off with a case-based discussion on the Centor Criteria and testing for strep pharyngitis. Drs. Walsh and Sabedra led an interesting discussion about a case of TTP. In his R4 Case Follow Up lecture, Dr. Nagle presented about DKA and family presence during resuscitation. Dr. Hogan, one of the EMS Fellows, gave a great presentation about the current controversies in cardiac arrest management. Finally, the week wrapped up with some great simulation and cases from our PEM fellows about post T&A bleeds, PTA, and acute chest syndrome.

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A Helping Hand

A Helping Hand

Medication Assisted Therapy or MAT is a critical component of the care and treatment of patients with opiate use disorder.  Over the course of the past several years, more and more ED providers, have been on the front line of initiating treatment of patients withdrawal symptoms and linking those patients to outpatient resources. In this post, we review the initiation of Buprenorphine based treatment for opiate use disorder in the ED.

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Enter the Centor

Enter the Centor

Strep pharyngitis, commonly known as “strep throat” is a bacterial infection of the oropharynx caused by group A beta hemolytic streptococci (GAS), specifically S. pyogenes. This infection affects more than 500,000,000 people annually worldwide per year, ultimately resulting in a significant number of doctor’s visits, including to the ED (1). The classic clinical presentation of GAS pharyngitis includes sudden onset of sore throat, fever, and odynophagia. If untreated, complications of GAS pharyngitis include scarlet fever, rheumatic heart disease, post-streptococcal glomerulonephritis and peri-tonsillar abscess.  In this post, we explore the diagnostic evaluation of pharyngitis with special attention to the use of the Centor criteria and rapid antigen testing.

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Grand Rounds Recap 9.4.19

Grand Rounds Recap 9.4.19

This week in grand rounds we discussed all types of critically ill patients, first covering the spectrums of hypothermia and shock. We then had a fascinating case follow up on a patient who developed torsades des pointes, and learned how to perform the HINTS exam and incorporate it into our practice. We then discussed pediatric osteomyelitis and it’s subtle presentation, and finally covered musculoskeletal ultrasound of the shoulder, knee, and ankle.

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Grand Rounds Recap 8.28.19

Grand Rounds Recap 8.28.19

This week started with a great Morbidity and Mortality Conference with Dr. Ham. Drs. Li, Makinen, Mand, and Skrobut then led small group workshops on HEENT emergencies. Following this, Dr. Harty led a fascinating discussion about a patient with Carotid Blowout Syndrome and Dr. Lagasse presented some of her work on trauma care and prevention from a Global Health perspective. The week wrapped up with Dr. LaFollette discussing arthrocentesis and joint loading in the emergency department.

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Grand Rounds Recap 8.21.19

Grand Rounds Recap 8.21.19

This week in grand rounds we started off reviewing the importance of matching the minute ventilation post intubation with airway master Dr. Carleton. We also reviewed salicylate overdose treatment with Dr. Owens as well as common and life threatening SCUBA emergencies with Dr. Comiskey. Finally, we finished the week off with a severe calcium channel blocker overdose and reviewed the treatment strategies to combat this extremely deadly overdose.

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Grand Rounds Recap 8.14.19

Grand Rounds Recap 8.14.19

This week we had a great mix of lectures on both pediatric and adult topics. Topics covered included pediatric ear, nose, and throat emergencies with Dr. Smith, pediatric GI bleeding with Dr. Bensman, anticholinergic poisoning and treatment of the critically ill seizing patient with Dr. Gleimer, a fascinating case of disseminated gonnorhea during of CPC with Drs. Berger and Baez, how to interpret volatile acid testing including the osmolar gap, and finally a great summary on the current standard of the diagnosis of subarachnoid hemorrhage with Dr. Murphy Crews.

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Diagnostics: Toxic Alcohols

Diagnostics: Toxic Alcohols

Anion Gap in you obtunded ingestion patient? Weekend gone dry and friends digging through the back of the cabinet? Join Dr. Kimmel as she discusses the diagnostics and therapeutics in toxic alcohol injections and when in doubt, bookmark this for a quick review of their toxicities and metabolites.

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Grand Rounds Recap 8.7.19

Grand Rounds Recap 8.7.19

This week started with some nutritional tips (and treats that cannot be shared on the recap) of how to get through a shift (and life) eating quality over quantity. This was followed by lecture of the best cases of the year by Dr. Benoit, contracts and bedside teaching small groups and Sports Medicine guru Dr. Betz took us through Hand cases in our community series discharge, transfer or admit.

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Controversies in Kidney Stones

Controversies in Kidney Stones

Flank pain and pain due to ureterolithiasis are common ED presentations. There exist, however, a number of controversies when you dive into the literature addressing the diagnosis and treatment of nephrology/ureterolithiasis. Is IV lidocaine effective at treating pain in these patients? Is there a way to avoid CT scans? What about tamsulosin? Is it only good for big stones/small stones? Is there a benefit at all. For our most recent Journal Club, we tackled several of these controversies. Take a listen to the podcast below or over on iTunes.

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Grand Rounds Recap 7.31.19

Grand Rounds Recap 7.31.19

This week Dr. Kathryn Banning led us in our first Morbidity and Mortality conference of the year. Dr. Banning led us through robust discussion about concurrent pathology presentations, biases and more. Air Care Grand Rounds followed, in which we reviewed aircraft operations and logistics with the Air Care team and went through a simulation case that highlighted the importance of stress inoculation.

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Grand Rounds Recap 7.24.19

Grand Rounds Recap 7.24.19

Grand Rounds this week started with our Leadership Curriculum, focusing on both positive and negative attitudes of leaders. Next, Dr. Hughes gave her Taming the SRU follow up lecture on debriefing and fat embolism syndrome followed by Dr. Spigner’s R4 Case Follow Up Lecture on streptoococcal toxic shock syndrome. The week wrapped up with simulation and oral boards practice covering acute right heart failure and anterior uveitis.

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Grand Rounds Recap 7.10.19

Grand Rounds Recap 7.10.19

We had a great week in Grand Rounds. The first lecture included a debate about the use of rocuronium or succinylcholine in paralysis for intubation by Drs. Lang and Plash. Drs. Ryan and Moellman led a thrilling discussion through some of their most interesting and thought provoking cases of their careers. Pharmacists Nicole Harger and Paige Gaber then discussed updates in pharmacy, specifically the use of droperidol and anticoagulation reversal in the emergency department. We learned about cognitive biases and clinical decision making from Dr. Hill. The day wrapped up with Dr. Knight showcasing the NIH stroke scale with Dr. Foreman.

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