Enjoy this week’s Grand Rounds Recap! Dr. Jordan Bonomo started us off with a fascinating talk on brain death, and how therapeutic hypothermia in the post-arrest patient can make this diagnosis more challenging. Next up, Dr. Harrison taught us some pearls on management of the bradycardic peri-arrest patient. Dr. Nagle shared with a us how to rescuscitate a patient with acute aortic dissection. Lastly, Dr. Summers talked to us about PRES and how to recognize and treat this rare disorder.Read More
This weeks grand rounds started off with our Morbidity and Mortality conference led by Dr. Shaw who led us on an education expedition covering the use of REBOA, surgical vs. medical management in spontaneous miscarriage, ways we can improve our use of the electronic medical record, management of a persistent air leak in a patient with a chest tube, and the role of CT in CAP. Dr. Alwan then provided us an in-depth look at the often untold challenges of life as a refugee as well as the challenges we face in providing care for these patients. This was followed by Dr. Randolph who presented a case of an incredibly complicated patient with a pulmonary embolism to highlight the steps in management of a decompensating patient with a pulmonary embolism before you initiate thrombolysis. Next up was Dr. Gottula and Dr. Hinckley who went head to head with a challenging presentation of acute aortic dissection as part of our CPC lecture series. Dr. Leech then finished up the day with a case based discussion on the utility of the Kocher Criteria in the evaluation of child with an acutely painful hip.Read More
This week started with our monthly Morbidity and Mortality conference where we discussed posterior MIs, tough dissections and more tough cases. We then heard a debate on the use of D-Dimer in the diagnosis of aortic dissection. Finally, we were led through a simulation of a sick GI bleed requiring Minnesota tube placement, and we discussed optimal management of these challenging patients.Read More
This week Drs. Harty & Gauger walked us through the literature surrounding the care of the patient in cardiac arrest as part of their Quality Improvement & Knowledge Translation project. Dr. Kristiana Kaufmann, a visiting professor from Wayne State, provided us a look at Global Health opportunities. Our Quarterly Simulation session, lead by Dr. Bryant, was a case of a 15 year old with new onset SOB and polyarthralgias. Lastly Drs. Stettler & LaFollette provided us with mock oral boards cases.Read More
You are working an busy overnight shift at your rural community ER when a nurse comes to notify you of a new patient in the lobby - there are no open beds currently, but she thinks he looks ill.
You go out to evaluate the patient quickly - He is complaining of severe generalized abdominal pain that started a few hours ago and is worsening. He looks pale and slightly diaphoretic, has severe abdominal tenderness with peritonitis. Concerned, you wheel him back to your trauma bay...Read More
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
The final Grand Rounds of 2017 opened with Morbidity and Mortality led by Dr. Kari Gorder. Drs. Liebman, Banning, and Owens then shared exciting Global Health cases from their travels to Tanzania and Guatemala. Dr. Grace Lagasse gave her soapbox lecture on firearm violence and the Emergency Department. Finally, our dentistry colleagues Drs. McMahon and Dagher refreshed our techniques and skills in the management of dental trauma.Read More
This week we learned about aortic dissection, the acute management of heart failure, hypertension in the emergency department, ophthalmologic emergencies, non-accidental trauma, and analysis of pleural and peritoneal fluid.Read More
Simulation with Dr. Hill
Transitions of care can be a high risk time for our patients, especially amidst the chaotic environment that can be the SRU.
Pre-planning sign out is an effective strategy to make the transition smooth. One to two hours out from the shift's end, take them time to start getting things in order for the end of the shift.
As emergency medicine physicians we have the tendency to want to wrap up our patients at sign out as nicely as possible. This is a good habit, realizing that it can predispose to premature closure, and, particularly in the case of an unpredictable SRU, should be applied with caution...Read More
M&M with Dr. LaFollette
Modified Sgarbossa Criteria to aid in diagnosing STEMI in the setting of LBBB
- Can be used in the setting of induced (paced) LBBB
- Unweighted scoring (any of the following indicates STEMI equivilance)
- Concordant ST elevation
- Concordant ST depression in V1,V2,V3
- Inappropriate discordance of >25% ST elevation / S wave amplitudes
- Improves your test metrics from the original criteria from sens/spec of 36%/96% to 80%/99% respectively in a new validation study
Beware! Aortic Dissection
#lessonslearned is a case series submitted by former senior residents describing B-pod cases that taught them the art of medicine
A male in his 30s with a past medical history significant for hypertension presented via EMS with pain all over, anxiety and shortness of breath. The EMTs reported that he had smoked marijuana about 30 minutes before his presentation from his normal supply. At the scene he was noted to be very agitated, diaphoretic and vocal about his pain. He was yelling that he was hurting all over, he was having trouble breathing, and that he wanted to be sedated. He states that he has never had problems like this.Read More