This week, we started Grand Rounds with ED-critical care research brought to us by UC Alumnus Dr. Brian Fuller. He discusses ventilator management in the ED and how ED sedation may affect patient outcomes. Dr. Harrison then presented an overview and common utilization errors of ED observation from his year as a Resident Assistant Medical Director, followed by Dr. McKee’s case of inhalational chlorine exposure. Dr. Alwan discussed updates to the less than 60 day fever protocol at CCHMC and Dr. Zozula walked through the dispatcher assistance protocols to give us an idea of what happens before they enter the ED doors.Read More
We know that alterations in hemodynamics do not only occur in hemorrhagic shock. Both obstructive (such as from tension pneumothorax) and neurogenic shock (for example, from a spinal cord transection), can result in hemodynamic compromise that would not be corrected by blood product administration. There have been some studies that have shown isolated traumatic brain injury (TBI) can also cause hemodynamic derangements. This article looks at a paper which attempts to examine the incidence of cardiovascular instability in patients with TBI.Read More
This was an exciting week of Grand Rounds discussions on a variety of topics. We began with a discussion of prehospital sepsis care and an update on EMS protocols in Southwest Ohio. The combined EM-Neuro conference provided a lively discussion on Guillain-Barre syndrome. The quarterly operations update was followed by a detailed discussion on esophagitis management in the ED. Finally, the pediatric fellows led a series of case discussions on a variety of devastating pediatric illness.Read More
This week's Grand Rounds opened with Dr. Curry discussing the paucity of literature on double defibrillation in VF. Dr. Mand then led small group discussions about the clinical utility of the pelvic xray. This was followed by Dr. Kreitzer expertly identifying incomplete Brown-Sequard Syndrome in Dr. Banning's CPC. Dr. Liebman discussed an interesting presentation of meningitis in a pediatric patient. Finally, our PEM colleagues led case based presentations of pediatric DKA, cat scratch disease, and a simulation featuring a patient in hypothermic cardiac arrest.Read More
This week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls. This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate. Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula. Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine. Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.Read More
This week's Grand Rounds served as our annual EMS Disaster day, where we tried on our HazMat gear, ran a mock mass casualty incident (MCI), and heard from Dr. Otten about his experience with multiple MCIs over the course of his career.Read More
This week we started out with a great presentation updating our Emergency KT and approach to alcohol withdrawal from Drs. Soria and Whitford. Drs. Brent and Curry updated us on the Southwest Ohio EMS Protocols and Dr. Neel gave us a wonderful overview of approach to peripheral neuropathies. We rounded out the day with Peds Simulation addressing CAH, congenital heart disease, and treating malnutrition in a remote setting.Read More
It is early October and you are the flight doc in C-pod on a brisk but clear Saturday morning. The day starts out with several challenging patients with vague complaints and has just begun to ramp up in volume when a patient rolls into your pod by EMS, restrained face-down to the cot, covered in feces and urine, screaming about hearing voices. You begin to take report from EMS when, as if by divine intervention, the tones drop and you are dispatched for an inter-facility transfer. You gleefully (almost too gleefully…) give a brief patient sign-out to your staff, grab the blood cooler, and head to the roof...Read More
Just prior to SMACC (the Social Media and Critical Care Conference), we were lucky enough to have Dr. Brian Burns of Sydney HEMS stop through Cincinnati. In the video below you can see his lecture on when the 1% makes all the difference. Dr. Burns talks about how we should strive for excellence in prehospital care not simply meeting minimum standards. Watch the lecture below to hear Dr. Burns discuss the importance of incremental changes, cognitive offloading, checklists, and continuous improvement and training through simulation.Read More
Thanks to everybody who commented and contributed to the discussion on our final “Flight!” If you missed out on the case, check it out here. Below you’ll find a curation of the comments to each question and a podcast with expert commentary from Jenn Lakeberg, APRN. This was the final “Flight” for this spring/summer. Look for the cases to return again in January 2016 as we begin Flight MD Orientation with the next class of future Air Care Flight Docs.Read More
Hey, everybody! Today we are going to talk about field limb amputation.
I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life.
First, let’s provide a little background on the pre-hospital limb amputation. The procedure itself has gained much more press in the FOAMed world and the emergency medicine and pre-hospital literature since the 2010 earthquake in Haiti during which early physician responders were faced with large numbers of patients trapped under debris and few responders with familiarity or basic working knowledge of the procedure (Lorich et al, 2010). A few of case reports and articles surfaced around this time and the field amp even made an appearance in an episode of the popular television show ‘Greys Anatomy’ in 2011.
So I was told…Read More
Social Media And Critical Care
- June 23-26, 2015
- McCormick Place, Chicago
Here at Taming the SRU, where we’ve been SMACC-infatuated for more than a year now, it’s easy for us to forget that many of you out there are still unfamiliar with what the fuss is all about. SMACC is the Social Media and Critical Care conference. Its next iteration, the third annual (and first to occur in North America), is coming in late June in Chicago, and wild horses couldn’t keep us away. Taming The SRU is honored and stoked to be an Affiliated SMACC Website.
Isn’t this just another CME conference, you ask? Emphatically, no. Weingart has called it “simply the greatest medical conference in the history of the world,” and we don’t think this is hyperbole. SMACC aims not only to educate; SMACC aims to entertain, and mostly, to inspire. To quote smacc.net.au: “SMACC is a high impact academic meeting fused with cutting edge online social media to deliver innovation with education. The underlying ethos is to provide free online education with open access, in what has come to be known as ‘FOAM’ (Free Open Access Meducation).” Get this: all sessions will be recorded and released as videos or podcasts online on the affiliated SMACC websites following the actual conference, for free! And yet, hundreds of us will flock to Chicago to attend in person. Why? We’re addicted to the inspiration of FOAMed, and the maximum dose of this inspiration attainable is SMACC, live and in person. (Plus, we’re sick of just ‘favoriting’ Minh Le Cong’s Tweets, and we want to shake his hand or give him a big ‘ol bear hug.) This is not your father’s medical conference. It’s infinitely better.
SMACC also aims to connect people across boundaries, and succeeds in doing so like no conference ever has. Wherever you practice critical care (prehospital, ED, OR, ICU), SMACC is for you. Whatever your discipline (student, EMT, medic, nurse, PA, NP, CNS, CRNA, doc), SMACC is for you. Whatever your specialty, whatever your experience level, whatever country you call home, whatever your clinical setting: as long as you seek inspiration to be as good as you can be at optimizing your sick patients’ outcomes, SMACC is for you. Right now, go to the brochure and look at it for just 60 seconds. Can you get a witness? You bet. Listen to this brief podcast in which Bill Knight, Jeff Hill, and I testify about the reasons for our excitement about our upcoming road trip to Chi-town. Still not sure? Check out the archives from SMACC 2014 (Gold Coast, Australia). We think you’ll be convinced. But, be forewarned: there’s no cure for SMACC addiction.
The State of Affairs
The morbidity and mortality of trauma on a global perspective is humbling. Aside from HIV/AIDS and TB, trauma is the chief cause of mortality for 15 to 45 years of age (based on 2002 WHO data). 5.8 million deaths annually. 5.2 million of those deaths, or 90%, occur in low-and-middle-income countries (LMIC’s). Prehospital care in LMIC’s varies immensely. Total prehospital time, the training level of prehospital providers, transportation method, and access to emergency medical systems (EMS) are some of the better described aspects of prehospital care in LMIC’s. The attributes of the prehospital health care delivery system differ significantly on a country by country basis.Read More
Recently, I had the pleasure of sitting down with Dr. Dustin Calhoun, EMS faculty member within the Department of Emergency Medicine at the University of Cincinnati.
Dustin had been responsible for an EMS fellow didactic session covering EMS scopes of practice and EMS licensure. While on the surface these topics may seem a bit “boring,” I found our examination of the complexities quite interesting. In fact, I found the session so useful that I asked Dustin to record this podcast with me (and I’m a former EMT!).Read More
I recently had the pleasure of sitting down with my co-EMS fellow, Dr. Ryan Gerecht, to discuss his experience with the implementation of a new blood product on our HEMS service: Liquid Plasma. Ryan was responsible for this implementation while serving as a Resident Assistant Medical Director during his last year of EM training at UC (2013-2014).
Here is what Ryan has to say…
In the Emergency Department, ICU, or operating room what do you resuscitate the hemodynamically unstable, bleeding trauma patient with? What about the patient with a massive GI bleed or ruptured AAA? How do you manage the patient with an intracerebral hemorrhage on Coumadin? (assuming you don’t have PCC’s readily available)Read More