This week's Grand Rounds started off with our monthly Morbidity and Mortality conference with Dr. Titone. This was followed by a lecture on pediatric bloody diarrhea with Dr. Shan Modi. Dr. Claire O'Brien then gave her Clinical Soap Box lecture on cost and waste within the healthcare system. Dr. Kreitzer then gave an evidence based lecture on current research in sepsis and refractory septic shock, followed by our consultant of the month lecture with Dr. Anthony Blanchard from podiatry discussing foot wounds and osteomyelitis.Read More
Dr. Titone held a great in-depth M&M this month with cases from tuberculosis to typhilitis (which is a thing). Drs. Baez and Goel took us through cases of coding Torsades and coding Pine Sol ingestions, followed by Dr. Skrobut who delicately closed the day with a discussion of testicular complaints in the ED.Read More
This week Dr. Gorder led us off with August's M&M cases, followed by Dr. Betz giving us great in-depth example of a proper joint exam from the perspective of sports medicine. Dr. Makinen gave us a talk of accidental hypothermia, Dr. Ludmer examined the link between chronic pain and depression and how concurrent treatment can help our patients quality of life. Dr. Wright gave us an update on UCEM Global Health and Dr. Colmer gave us a look into the critical care management of a DKA case.Read More
This week's Grand Rounds began with Quarterly Sim led by Dr. LaFollette who walked us through a case of cardiogenic shock and neutropenic fever. Dr. Curry led us through an oral boards triple case with an unstable MCC, a FB ingestion and perforated viscous. Dr. Hill presented an eOrals case of thyroid storm. Lastly was PEM-EM combined conference, led by Dr. Wurster Ovalle, which focused on the treatment of pediatric DKA with a special focus on cerebral edema.Read More
This week Dr. Axelson took us through great DKA in pregnancy, hyponatremia tips, and prioritization in UGIB in this month's M&M. Critical Care bound Dr. Renne laid out some intra-arrest tips and Dr. Brown from Cincinnati Children's talked about Adult Congenital Heart Disease. Small groups covered everything from ACLS logistics to shoulder US to Minnesota tube insertion.Read More
Dr. Axelson kicked off Grand Rounds this week with a look at DKA, hypercalcemia, suicide in the ED and more during M&M. Then we learned about Hereditary Angioedema, Thyroid Emergencies, Concussions, NIPPV and got a chalk talk about setting end goals of resuscitation from Dr. Dave Norton.Read More
Remember the "I's" when looking for cause of DKA/HHS: Infection, Insulin lack, Infarction (MI, CVA, Ischemic gut), Indiscretion (EtOH, cocaine), Infant (pregnancy).
After 2L NS fluid bolus in the hemodynamically stable patient, the corrected sodium should guide fluid choice for further therapy.
Venous pH, HCO3 and base excess have sufficient agreement to be interchangeable with ABG in the ED.Read More