We had a jam packed Grand Rounds this week kicked off by Dr. Carleton's airway lecture discussing tools to maximize fiberoptic intubation success. Next Drs. Roche and Plash led us through wilderness medicine small groups discussing plant ingestions and creative extrication techniques. Drs. Murphy-Crews and Bryant participated in a CPC case with a seizing neonate followed by Dr. O'Brien's discussion of blunt neck trauma. Next Dr. Cotton presented data on physician burnout and how to combat it while Dr. Li wrapped things up with an overview of Kawasaki's disease.Read More
Dr. Carleton started things off with a review of oral fiberoptic intubation and a step by step guide to trach recanalization. Next we headed off to EM-Neuro combined conference where Dr. Neel discussed headaches that kill, headaches that maim and headaches that annoy. Dr. Thompson walked us through a case of vertebral artery dissection and Dr. Liebman kicked off our wellness curriculum. Dr. Roche finished things up with a discussion the nuances of toxicology in the community.Read More
Look Before You Leap, Drive Your Ferrari Like it is a Wheelchair, Harken Ye to the Wicked Witch of the West!
A 37 year-old woman presents with stridor, drooling, tachypnea and accessory respiratory muscle use. She has an adequate blood pressure, but is tachycardic to 120. Her oxygen saturation on room air is a reassuring 97%. She cannot answer questions, appears to have an altered mental status though she follows commands, and suddenly has a brief period of either myoclonus or seizure with unresponsiveness. No post-ictal period is noted after this episode.Read More
Like all procedures, success in the performance of an awake fiberoptic intubation comes from proper preparation. Preparation for this procedure means so much more than proper preparation of the patient (preoxygenation, positioning, local anesthesia, etc.). To be fully prepared is to have a well practiced, working knowledge of your equipment and the options you have in setting it up. To be fully prepared is to be practiced in the motor skills necessary to drive the scope, advance the tube and troubleshoot as you go.Read More