Grand rounds this week started off with a review of the EMTALA law with Dr. Hinckley, as well as some case discussion. This was followed by a presentation from our clinical pharmacists, PharmD's Nicole Harger and Madeline Stephens, on anti-epileptic medications and their uses, as well as an update on our medication supplies in the ED. Drs. Murphy-Crews and Scanlon then presented their evidenced based algorithm for the management of STEMI, followed by our combined peds EM lecture with Dr. Kevin Overmann on the evaluation of the pale child and pediatric anemia. This was followed by Dr. Ludmer's R4 case follow up/best of residency cases. The day finished up with Dr. Sim Mand presenting her clinical diagnostics lecture on the assessment and management of the non-pregnant patient with abnormal uterine bleeding.Read More
This week in the Grand Rounds Recap, Dr. Richardson gives us the quick and dirty of constipation, Drs Jarrell and Kircher discuss cases of laboratory study interpretation in liver disease. In addition, Dr. Carleton reviews the anatomy of femoral nerve blocks and Dr. Klasky discusses how we should be approaching non-hemorrhagic anemia in the ED.Read More
IABP With Dr. Wojciechowski
- What is it? It's a ~10cm long intravascular balloon that inflates with 25-50ml of helium gas during diastole to increase the coronary perfusion pressure and decrease the afterload on the heart (coronary perfusion pressure = diastolic blood pressure - left ventricular end diastolic blood pressure). The catheter itself has a pressure transducer and a catheter that shuttles the helium gas.
- Why helium? it is low density, metabolically inactive, and dissolves in blood in case the balloon were to rupture.
- Who gets one? In general they are reserved for hemodynamically unstable patients as salvage therapy (STEMI with cardiogenic shock, acute MI that can't be reperfused, high risk CABG, failed maximal medical therapy).