Ventricular dysrhythmias are commonly caused by coronary ischemia which is most frequently caused by acute coronary artery occlusions in the setting of coronary artery disease. It would seem somewhat logical that patients who suffer a V fib or V Tach cardiac arrest would benefit from a trip to the cardiac catheterization lab to identify and treat these possible acute coronary artery occlusions. Patient’s with EKGs showing ST-elevations following ROSC already go to the Cath lab. Since the EKG is not terrifically sensitive for MI, should V fib V Tach cardiac arrest patients without ST-elevations make a trip to the Cath lab? In this breakdown of our most recent journal club we look at several papers covering this topic. In the podcast below we also talk with Justin Benoit, MD the site PI for the ongoing ACCESS trial which is also looking into this question.Read More
Come check-out our Grand Rounds Summary for 12.19.18! We started the morning with some fascinating cases in Morbidity and Mortality Conference with Dr. Baez. Next, we learned the importance and efficacy of mindfulness with Dr. Bernardoni. Dr. Makinen and Dr. Curry went head-to-head on a Clinical Pathologic Conference about a patient with hyperthermia due to sympathomimetic overdose. Lastly, Dr. Frederick taught us the evidence behind PECARN!Read More
From epi drips to peds fracture tips, it was an eventful Grand Rounds. We began with a debate on the utility and method of epinephrine during cardiac arrest. Dr. Murphy then discussed hemodialysis access complications followed by Dr. Palmer’s operations update. Dr. Shah led a discussion on the recognition and management of pediatric fractures. We concluded by covering a variety of other pediatric topics during the R3 small group session. Take a look!Read More
The first of a new series of posts with associated podcasts looking at the literature behind what we do every day in the ED with takeaways of tangible algorithms to guide every day practice. This month Drs Gauger and Harty lead us in a discussion of cardiac arrest, the drugs we use, the ultrasound we dabble with and the future interventions that could become standard of care.Read More
This week’s Grand Rounds started with Dr. Gorder’s expertly delivered Morbidity and Mortality lecture. Dr. Gottula then went over drugs of abuse, including the gabapentinoids. Dr. Shaw then talked about a case of sympathetic acute crashing pulmonary edema (SCAPE). Finally, Dr. Edmunds spoke about pediatric renal emergencies.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
This week’s Grand Rounds was kicked off with our W. Brian Gibler visiting professor series with Dr. Ali Raja M.D., MBA, MPH, and Vice Chair of Emergency Medicine at Massachusetts General Hospital. He gave us his insights on how to help move our specialty towards evidence based practice, as well as his tips on leadership within the context of academic emergency medicine. This was followed by our monthly Morbidity and Mortality Conference with Dr. Titone. Dr. Shah then gave his R4 Clinical Soap Box on the utility of ultrasound in cardiac arrest, and the conference finished with Dr. Whitford giving his R3 Taming the SRU case follow up.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 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
This week we had a Grand Rounds jam packed with clinical knowledge. When was the last time you considered the differential diagnosis of an elevated troponin? It's not just ACS! Read on to learn more about thyroid storm, refractory Vfib and Vtach, lithium toxicity, inflammatory markers, and more. As well as a special clinical soapbox about how Ohio became the epicenter of the nation's heroin epidemic.Read More
The UC Division of EMS has recorded a series of podcasts to celebrate EMS Week 2016. We are honored to be able to engage EMS Providers throughout the world with this forum. If you practice pre-hospital medicine, we would like to say thank you and that we appreciate everything you do to provide a high level of care to ill and injured patients in a wide variety of austere environments. For this podcast, we were joined by Dr. Dustin Calhoun, Associate Director of the UC Division of EMS, as well as two of this year’s UC EMS Fellows, Dr. Mike Bohanske and Dr. Justin Benoit.Read More
A couple of weeks back, we kicked off our “Flights” portion of our Air Care Orientation Curriculum. Dr. Latimer outlined a challenging patient case for use to consider and an excellent discussion ensued. As a reminder of the case, here’s how it was posed:
Your patient is a 56 year-old male with unknown medical history who was an un-helmeted motorcyclist found in a ditch roughly 40 feet from his motorcycle which was discovered in the middle of the road by a passing motorist. The accident was un-witnessed, but the bike was found just beyond a sharp downhill curve in the rural farm road. EMS has BLS capabilities only and they have placed the patient on a backboard and loaded him into the unit.Read More
Morbidity and Mortality Conference with Dr. Toth
- Clinical Decision Unit Usage: We want to keep using our observation protocols for patients that are appropriate for the CDU. These patients must have a priori identifiable endpoints and a plan for care.
- Discharge vital signs: Revisiting a theme from last month, tachycardia at discharge is associated with badness. Abnormal vital signs must be addressed.
- Shift Change: Turnover is fraught with increased risks regarding patient care. Be vigilant that your sign out can anchor the oncoming provider.
This week we recap the latest IOM recommendations on cardiac arrest management, evidence-based update on anaphylaxis management, management of the morbidly obese code and discuss the ins and outs of immunosuppressive agents.Read More
Thanks to everybody who chimed in on our last "Flight"! We had a great discussion on the management of the STEMI transfer patient. These aren't just "milk runs" as pointed out by Dr. Hinckley. The highlights of the discussion are below with additional commentary on the case by Dr. Bill Hinckley and Air Care Resident Assistant Medical Director Dr. Matt Chinn. Out final flight will be lifting off June 1 and it's a doozy - looking forward to the discussion!Read More