The Thinker

The Thinker

The reality of the Emergency Department is that not everybody is sick, but every patient could be sick. The task of finding the sick patients among the non-sick is far more challenging than it may appear and the diagnostic process is far more fraught with potential sources of error than one would like.

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Grand Rounds Recap 7.3.19

Grand Rounds Recap 7.3.19

Welcome to the new Academic Year! We started the year off with Dr. Pancioli giving us some context of how EM got to where it is and where it is going. Dr Palmer then inspired us to consider our role in the teamwork that is patient care. Dr McDonough then led us in an exercise of delivering bad news to patients, and some of the nuance that is dealing with breadth of reactions to it.

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Is the Cath Lab the Place to be after V fib VTac Cardiac Arrest?

Is the Cath Lab the Place to be after V fib VTac Cardiac Arrest?

Ventricular dysrhythmias are commonly caused by coronary ischemia which is most frequently caused by acute coronary artery occlusions in the setting of coronary artery disease. It would seem somewhat logical that patients who suffer a V fib or V Tach cardiac arrest would benefit from a trip to the cardiac catheterization lab to identify and treat these possible acute coronary artery occlusions. Patient’s with EKGs showing ST-elevations following ROSC already go to the Cath lab. Since the EKG is not terrifically sensitive for MI, should V fib V Tach cardiac arrest patients without ST-elevations make a trip to the Cath lab? In this breakdown of our most recent journal club we look at several papers covering this topic. In the podcast below we also talk with Justin Benoit, MD the site PI for the ongoing ACCESS trial which is also looking into this question.

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Grand Rounds Recap 6.26.19

Grand Rounds Recap 6.26.19

This week was the last grand rounds of the academic year. We started off with the monthly Morbidity and Mortality conference led by Dr. Colmer. This was followed up by a CPC on Infectious Mononucleosis from Dr. Jensen and Dr. Stolz. Dr. Urbanowicz then discussed if there is a use of platelet function studies in the Emergency Department. The day ended with Dr. Murphy-Crews describing a fascinating case of severe hypothermia and outlining the interventions available to us in the ED for these patients. See you next week!

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Grand Rounds Recap 6.19.19

Grand Rounds Recap 6.19.19

This week we had our annual Disaster Day. We started with the legendary Dr. Otten giving us a rundown on disaster preparation and planning. Dr. Calhoun then led us through our disaster activation protocols at UCMC. We then used these principles in a complex mass casualty even simulation. The day ended with an analysis of how these protocols worked in real life during the Fifth Third Shooting.

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Grand Rounds Recap 6.12.2019

Grand Rounds Recap 6.12.2019

This week we had a wide array of topics covered in Grand Rounds. Dr. Continenza started our morning off discussing coping strategies for difficult pediatric patient encounters. Next, Dr. Gauger took us through the toxicology and treatment of calcium channel blocker overdose. Dr. Bernardoni had a fantastic capstone combing a number of high yield visual diagnosis. Lastly, Dr. Wilen took us through a pediatric simulation of undifferentiated pediatric jaundice. Enjoy!

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Grand Rounds Recap 6.05.19

Grand Rounds Recap 6.05.19

We hope you enjoy this week’s Grand Rounds Recap from 6.05.2019. We started the day with a talk on how to master the extraglottic device during Airway Grand Rounds with Dr. Carleton. Next, Dr. Liebman talked about error reduction in Airway Management with the use of checklists. Dr. Shaw then presented a fascinating case of Guillain-Barre Syndrome. Dr. Walsh shared some pearls as to how to utilize the Sgarbossa Criteria. Lastly, we were honored to have Dr. Dunlop talk to us about trauma in the developing world during Global Health Grand Rounds.

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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.

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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.

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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.

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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!

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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.

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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.

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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.

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