This week we learned from Dr. Palmer the key skills of dealing with failure - how do we recognize it and how do we shape our behaviors because of it. Dr. Shah, Peds EM fellow then discussed a differential of stridor in the pediatric patient.Read More
This week's Grand Rounds were jammed packed with Ultrasound Guided Regional Anesthesia pearls, first from Dr. Carleton and then from Drs. Dang and O'Brien. Drs. Thompson and Lagasse walked us through can't miss x-rays during small groups. Dr. Nagle taught us about pediatric EKGs.Read More
Dr. Ventura discusses the value of head CT and risk factors of CNS complications in HIV. Dr. Goel discussing the cognitive biases that drive decision making in EM. Dr. Stettler taught us that framing feedback can be as important as giving it and finally our CCHMC colleagues run through some difficult tox and airway cases. Plenty of learning to go around this week!Read More
This week, Dr. Boyer led us through his R4 case follow up. Drs. Baez and Summers dove deep into the literature on sepsis. Dr. Gauger reviewed toxicologic syndromes. Dr. Axelson hit us with some trauma pearls and we worked through sick respiratory cases during our combined Peds-EM sim.Read More
This week we got put in the hot seat with oral boards on AAA rupture, SVT and eclampsia, a simulation with end-of-life discussions, a critical beta blocker overdose from Dr. Lagasse and some Peds EM tips on conscious sedation from Cincinnati Children's PEM Fellow Dr. Lee. Click to check out more highlights from this week's Grand Rounds!Read More
Elbow injuries account for 2-3% of all emergency department visits across the nation (1). Yet, because of the elbow’s complex anatomy and the presence of numerous ossification centers in children, elbow fractures are the third most commonly missed fracture group in the ED (1). Here are some tools to help ED physicians read elbow x-rays more effectively and hopefully identify abnormalities more easily...Read More
Imagine it’s your first moonlighting shift at a small rural community hospital. The nearest referral center for both adults and children is 90-minutes away by ground. The annual census of the emergency department is 15,000 patients per year, of which only 5% is pediatric. There are 2 hours left in your 12-hour shift and your energy is all but spent. You are looking forward to winding down at home after an extremely busy and high-acuity shift when your 35th patient of the day checks in. The patient’s chief complaint is fever. You give yourself an internal fist pump thinking that you’re about to see your 12th viral URI of the day and that you’ll be in-and-out of that room no in time. In the midst of your premature celebration you scan the nursing note and see the age of the patient: 6 weeks…You’re hopes of a quick and easy disposition suddenly melt away leaving you with many more questions regarding this patient’s care than answers…You muster your remaining energy and make your way toward the patient’s room.Read More
R4 QUARTERLY SIMULATION with Drs. Curry, Loftus, Ostro and Strong
We presented a case of a 42 y/o female who presented with altered mental status, hypotension and bradycardia. She was ultimately found to have an unintentional labetalol overdose which she had been taking PRN for headache.
Beta-Blocker Overdose Take-Home Points...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
The patient is a healthy 3 week old male with no past medical history. He was born full term via uncomplicated Cesarean Section who presents with increased fussiness. His mother states the patient has simply not been acting like himself. He was taken home on hospital day 1 without issues, but in the last 24 hours, he has been quite fussy. His mother became concerned when he was unable to take his bottle today. The child has been refusing to eat and has been increasingly difficult to console. He has also had less wet diapers than normal today. Mom has not noticed cyanosis during feeding, recent illnesses or fevers. She also denies the presence of emesis, diarrhea, rashes, congestion, or cough.Read More
This is our final recap of our "Out on a Limb" Case Series! If you missed the initial "Moonlighter" case and discussion you can check it out here. There were a number of great responses to the questions which we'll recap below.
Q1 - What are your options in handling this situation?
You have a few options in handling this situation. As many of the respondents chimed in, the wound definitely needs to be cleaned out and closed and the patient requires antibiotics as soon as is reasonably and safely possible, especially since the injury is already 6 hours old. The first option is to complete a sedation and multilayer repair in the ED yourself. As many people point out, this is not an excellent proposition unless there are extreme extenuating circumstances.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
Pressor Primer with Dr. Hebbeler-Clark
- Norepinephrine seems to be on top in terms of vasopressor of choice currently (consider it your "easy button")
- Per Surviving Sepsis Guidelines, Norepi has level 1B evidence as a first line pressor, while Epi is your second line with level 2B evidence and Vasopressin is currently ungraded in terms of evidence level
- There have been 4 RCT's confirming that Norepi has no mortality difference from Epi and given it's safer side effect profile, use it regularly
R4 Simulation Series: Genitourinary Emergencies with Dr. Moschella and Dr. Verzwyvelt
- Fournier's Gangrene (ie necrotizing fasciitis of the perineum): Case simulation of 19 yo M with tachycardia, hypotension, altered mental status found to have erythema, induration, and crepitus of the perineum. Initial steps are aggressive treatment of sepsis (broad spectrum antibiotics to cover skin and gut flora as this is commonly polymycrobial) and early surgical debridement. Either Urology of Acute Care Surgery will mobilize to perform the debridement.
- Oral boards case: Consider ovarian torsion in young female with acute onset pain in lower abdomen or pelvis. You may find adnexal fullness or tenderness on exam. Diagnostic test of choice is transvaginal duplex ultrasound. Remember to include ectopic pregnancy, appendicitis, TOA in your differential.