This week, we reviewed new EMS protocols, learned about rare pathologies like tumor lysis syndrome and anterior cord syndrome, simulated a case of an aortic dissection, and practiced visual diagnoses in pediatric patients.
Read MoreThis week’s grand rounds features an overview of crush injuries with Dr. Della Porta, a fantastic look into the evidence behind preeclampsia and eclampsia management with Drs. Brower and Jackson, a discussion of evidence behind emergency medicine pharmacology dogma with Dr. Nagle, and a discussion of the cost of healthcare with Dr. Thompson.
Read MoreStarting off the week with Drs. Jarrell and Yates defining what advocacy looks like in leadership. Drs Finney and Chuko led us in two case follow up discussions featuring how to deal with early misses and Hickam’s Dictum. Finally the Cincinnati Peds team leads up in simuations of Status Asthmaticus.
Read MoreJoin Us for another week of Grand Rounds as Dr. Boldt takes us through ED management of obstetric emergencies, Dr. Zalesky reviews a year of emergency medicine literature in a blitz, Dr. Hassan discusses ultrasound vs physical exam in modern emergency medicine, and our PEM colleagues take us through Ketamine laryngospasm, neonatal jaundice, and bacterial tracheitis.
Read MoreThis week’s Grand Rounds was kicked off with our inaugural “The Art of EM” lecture that included a panel of our esteemed non-UC trained faculty members Drs. Lang, Minges, D.Thompson, Adan, and Stolz. Dr. Gillespie then expertly led us through hand infections in her R1 Clinical Knowledge lecture. Drs. Comiskey & Crawford took us on a deep dive of the literature surrounding the evaluation and management of DVTs. Lastly, our PEM colleagues walked us through a great video-simulation case series on critical pediatric cardiac pathology!
Read MoreRenal colic is a common presenting symptom in the ED, with an estimated prevalence as high as 10-15% in the US. (1) It accounts for approximately 1% of all ED visits per year. (27) Most patients will pass these calculi spontaneously and do not require surgical intervention, therefore focus on pain relief is of utmost importance in the emergency department. (1) NSAIDs have shown to be as effective, if not more effective than opioids, making them a reliable first line agent. (4,5) Opioids still provide a viable option in those with kidney disease or gastric ulcer disease, however they may be best utilized as combination agents to decrease the need for rescue analgesia. There is weak evidence to support the use of IV acetaminophen, with high cost burden, limiting its utility. Additional agents such as ketamine, lidocaine and magnesium carry with them limited evidence and inconsistencies in the literature, limiting their use, with further studies required. Alpha blockers seem to provide a shorter duration to expulsion, fewer pain episodes, and less hospital admissions with surgical intervention, specifically with larger stones (>5mm).
Read MoreAgitation? Second nature to most Emergency Physicians but an art as much of a science. The science lays the backbone of this art, however and that’s where Dr. Courtney Kein comes in. Click and join us on a dive into the literature of sedation of the agitated patient.
Read MoreIn our most recent journal club, we took a look at 3 articles focused on the use of ketamine in the Emergency Department. When treating pain with ketamine, does a rapid administration of ketamine result in more dysphoria? When used for RSI, is ketamine more hemodynamically stable than etomidate? When using ketamine for procedural sedation in adult patients, does pre-treatment with versed or haldol decrease clinically significant emergence agitation?
Read MoreThis week we disccused interventions for the crashing asthma patient with Dr. Mand, ESRD and dialysis related complications with Dr. Scanlon, shoulder and elbow xrays with Drs. Crawford and Scanlon, and a case of intussusception in an adult patient with Drs. Hunt and Bryant. Dr. Gauger provided his case follow up on PJP pneumonia complicated by methemoglobinemia, and Dr. Li took us through the ins-and-outs of gastric lavage in a simulated case of calcium channel blocker overdose.
Read MoreEnjoy this week’s Grand Round’s Recap. Dr. Murphy started us off with a great Morbidity and Mortality conference with a variety of fascinating cases. Next, Dr. LaFollette taught us some pearls for HEENT emergencies if you are out in the community. Dr. Hunt took us through transfusion reactions and how to manage them, followed by Dr. Hall discussing the management pearls of Nonconvulsive Status Epilepticus. Next, Dr. Connelly taught us how we can incorporate alternative EKG leads into our practice, and Dr. Klaszky finished our day with a nuanced take of how to manage refractory septic shock. It was a jam packed day full of great learning!
Read MoreThis week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls. This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate. Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula. Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine. Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.
Read MoreThis week in UCEM Grand Rounds: the harrowing story of the desaturating trauma patient with a metal pole impaled through his mouth and neck. Also: making the diagnosis of HIV in the ED. Managing hemorrhagic shock on Air Care. How much did that ED visit or hospitalization cost your patient? Managing tachy-arrhythmias in the setting of cardiac arrest with a pacemaker.
Read MoreWho do we RSI? What do we use? We can be better than etomidate and succ and the protocol in development will drill into the details - here is an overview:
I don’t know if this has happened to you yet. It happened to me on my first shift as an intern. I hadn’t laid hand on a stethoscope in months. I had just unloaded the cardboard boxes from my rental truck into my new place. As I was settling in to my first few patient encounters one of our nurses approached me to say that a patient had been brought into our area that was extremely agitated. I looked up to see a man being held down by multiple police officers, thrashing and swearing.
“What can I give him?” She said.
“How about a hug?” I replied.
Read MoreThe Sick Patient with Pulmonary Artery Hypertension (PAH)
SRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
