Grand Rounds Recap 12.7.22
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This week, we had two phenomenal guest lecturers, held Airway Grand Rounds, reviewed pediatric burns, and heard about how point of care ultrasound can change practice in the emergency department.
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Grand Rounds Recap 2.2.22
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In this week’s Grand Rounds, Dr. Laurence led us through an incredible and education Morbidity and Mortality Conference, Drs. Gillespie and Continenza worked through a dramatic case combining vision changes and rash, Dr. Wright reminded us to not forget the esophagus in our patients with chest pain and Dr. Connelly gave a fantastic overview of EMS provider education and systems structure in her R4 Capstone. Finally, our incredible visiting professor, Dr. Megan Rybarcyzk gave us insight into building an emergency medicine education program in the midst of a pandemic and provides tips and tricks for those seeking a career in global health.
Read MoreUS Case of the Month - Watchers of the Walls
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Dr. Mand brings Ultrasound Case of the Month into the new decade with a thorough discussion of echocardiographic evaluation of patients with suspected acute coronary syndrome (ACS) in the emergency department, including limitations, correlation with other established diagnostic modalities, and a review of the existing evidence.
Read MoreSTEMIs in Disguise
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The 2013 ACC/AHA STEMI guidelines outline, with specific age and gender-related cutoffs for ST segment elevation in certain leads. While these are clinically important, there are several STEMI equivalents or EKG patterns that do not meet these criteria but should point the practitioner to consult with an interventional cardiologist. These STEMI equivalents are found in 10-25% of cases of coronary occlusion, making it imperative that emergency personnel be familiar with these patterns.
Read MoreGrand Rounds Recap 10.16.19
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This week we disccused interventions for the crashing asthma patient with Dr. Mand, ESRD and dialysis related complications with Dr. Scanlon, shoulder and elbow xrays with Drs. Crawford and Scanlon, and a case of intussusception in an adult patient with Drs. Hunt and Bryant. Dr. Gauger provided his case follow up on PJP pneumonia complicated by methemoglobinemia, and Dr. Li took us through the ins-and-outs of gastric lavage in a simulated case of calcium channel blocker overdose.
Read MoreGrand Rounds Recap 4.24.19
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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.
Read MoreA Weakness in the HEART?
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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?
Read MoreGrand Rounds Recap 4.25.18
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This week’s Grand Rounds was kicked off with our W. Brian Gibler visiting professor series with Dr. Ali Raja M.D., MBA, MPH, and Vice Chair of Emergency Medicine at Massachusetts General Hospital. He gave us his insights on how to help move our specialty towards evidence based practice, as well as his tips on leadership within the context of academic emergency medicine. This was followed by our monthly Morbidity and Mortality Conference with Dr. Titone. Dr. Shah then gave his R4 Clinical Soap Box on the utility of ultrasound in cardiac arrest, and the conference finished with Dr. Whitford giving his R3 Taming the SRU case follow up.
Read MoreThe Radioactive Heart
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For Journal Club this past week we covered what is undoubtably one of the more controversial diagnostic tests used in the evaluation of patients presenting to physicians with chest pain. The most recent NICE guidelines recommend Coronary CT as the first line test for patients with stable angina symptoms but don't Coronary CT's lead to increased downstream testing? more radiation exposure? To investigate this topic we took a look at 3 articles focused on the utility of Coronary CT scans. Take a listen to the podcast and read the recap to learn for yourself.
Read MoreGrand Rounds Recap 6.28.2017
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The last Grand Rounds of the 2016-2017 academic year kicked off with M&M with Dr. Betham presenting on EKGs, vitamin deficiencies, sepsis and hemorrhoids. Dr. Deb Gerdes brought us a global health update and Dr. Titone taught us about hyperthermic emergencies.
Read MoreGrand Rounds Recap 8.17.2016
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This week included our first every chalk-talk about antibiotics focusing on beta-lactams. We had our quarterly AirCare grand rounds where we learned about some special tools we carry on the aircraft including point of care lab testing and specialized suction devices. We also did a high fidelity hemorrhagic shock simulation. In two case follow-ups we learned about some special considerations in ACS and for pregnant patients in trauma. Read on!
Read MoreGrand Rounds Recap 12/16/15
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"IN JEOPARDY", AN ACS REVIEW - DR. FERMANN
EKG Changes
- According to the AHA, there are no diagnostic EKG changes for NSTEMI
- ST elevations in II, III and aVF with depression in V2 represents and inferior-posterior STEMI
- ST depressions in the precordial leads may represent posterior MI
- Continuous ST segment trend monitoring may pick up very dynamic ischemic changes (though this is almost never done anymore)
STEMI and STEMI Equivalents, i.e. Who Needs the Cath Lab Now!
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1. The ACC/AHA Criteria (1) (2)
ST-elevation in 2 contiguous leads that is:
Men < 40: 2.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
Men > 40: 2.0 mm ST-elevation in V2 or V3, 1 mm in any other lead
Women: >1.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
STEMI's have a 90-minute door-to-balloon time mandate from the Center for Medicare Services (CMS). To be good stewards of our resources we need to be familiar the false positive STEMI patterns. Ultimately, however, some degree of over triage and activation for false positives is expected and (potentially even) desirable.
Read MoreGround Rounds Summary 8/19/15
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Simulation - Clonidine Overdose
- 30 yo FM presents after having taking a handful of pills with the following VS: HR 45, BP 83/60, RR 8, 100% RA, T 98. FS101. It gets better—there's a baby behind that baby bump.
- Ddx for AMS, hypotension and bradycardia? Tox, hemoperitoneum, spinal shock, myxedema coma, and a quite atypical sepsis.
- By EMS report this lady reportedly took a handful of unknown pills in an effort to harm herself. Remember to consider clonidine overdose in addition to beta blockers and calcium channel blockers. This lady found herself a bottle of clonidine and a near successful suicide attempt.
