Grand Rounds Recap 7.10.19

Grand Rounds Recap 7.10.19

We had a great week in Grand Rounds. The first lecture included a debate about the use of rocuronium or succinylcholine in paralysis for intubation by Drs. Lang and Plash. Drs. Ryan and Moellman led a thrilling discussion through some of their most interesting and thought provoking cases of their careers. Pharmacists Nicole Harger and Paige Gaber then discussed updates in pharmacy, specifically the use of droperidol and anticoagulation reversal in the emergency department. We learned about cognitive biases and clinical decision making from Dr. Hill. The day wrapped up with Dr. Knight showcasing the NIH stroke scale with Dr. Foreman.

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Grand Rounds Recap 1.30.19

Grand Rounds Recap 1.30.19

Welcome to another grand rounds recap! This week Dr. Isaac Shaw started us out with the monthly Morbidity and Mortality. Dr. Stolz then dove into some ultrasound QA, covering topics such as knee arthrocentesis and early pregnancy ultrasound. Dr. Murphy followed this up by discussing the science of motivation and how we can use this in the Emergency Department setting. This was followed up with Drs. Modi and Kircher who went head to head in this months CPC on endocarditis. Dr. Irankunda finished up the day with an excellent talk on the retrograde urethrogram. See you next week!

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Grand Rounds Recap 1.31.18

Grand Rounds Recap 1.31.18

In this week's grand rounds, Dr. Stolz discussed all things DVT and the modified two-point compression study for lower extremity clots. In our recurring EM-neuro combined conference, Dr. Stettler discussed the recent DAWN trial results, and how to incorporate CT perfusion studies into our acute ischemic stroke decision trees. In our Quarterly Sim, we discussed the management of the crashing patient from a house fire, and practiced our escharotomy skills. In our mock oral boards, we went through cases on STEMI, carbon monoxide exposure and limb ischemia. Finally, Dr. Lane discussed the workup of acute diarrhea in the adult population, and Dr. Shah went through a particularly unique toxidrome presentation in his R4 Case Follow Up. 

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Grand Rounds Summary 9.20.17

Grand Rounds Summary 9.20.17

This 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.

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Grand Rounds Summary 9.13.17

Grand Rounds Summary 9.13.17

'Twas a fantastic grand rounds.  Drs. Banning and Golden started it off taking us through the most recent evidence for management of sub-massive and massive PE, as well as presenting their algorithm to be published on Emergency KT.  This was followed by a global health lecture given by Dr. Lagasse, which covered a range of re-emerging infectious diseases.  Next, Dr. Bryant took us through multiple pediatric cases, and discussed her approach in determining whether to discharge, transfer, or treat pediatric patients with common / representative complaints.  Dr. Adeoye then took us through the history and development of our current approach to the management of acute ischemic stroke.  Dr. LaFollette then took us through an evidence based approach to removing things from where they shouldn't be in his edition of mastering minor care, discussing approaches to removing retained objects from ears and skin.  We then finished the conference with two interesting cases:  One presented by Dr. Sabedra that was followed by a discussion on the diagnosis and management of massive hemoptysis, and the other presented by Dr. Dang illustrating the differences and similarities hyperthermic toxidromes including NMS and serotonin syndrome as well as their management.  

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Grand Rounds Recap 02.08.2017

Grand Rounds Recap 02.08.2017

This week we had the distinct privilege to learn about empathy from Dr. Ope Adeoye who explored what empathy looks like from the patient's perspective - and why it's difficult to be truly empathic as a young physician. We puzzled over a CPC case of severe chest pain in a young woman. Dr. Harty taught us about the not-so-elusive TACO and TRALI among other transfusion reactions. Finally, Dr. Wurster-Ovalle gave us some pointers on management of unvaccinated children with fever in the ED.

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Grand Rounds Recap 6/22

Grand Rounds Recap 6/22

MORBIDITY AND MORTALITY CONFERENCE WITH DR. DENNEY

Stroke Chameleons

  • Stroke chameleons are atypical presentations of stroke and are associated with delays in diagnoses and failure to administer intervention when otherwise indicated
  • Maintaining a diagnosis of stroke on the differential is paramount to being able to diagnose a chameleon. Characteristics of chameleons that we most frequently miss are:
    • Atypical presentations (we miss 4% of typical vs 64% of atypical) 
    • Strokes in the young
    • Cerebellar strokes
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Grey Matters - Recap of Flights Case 3

Grey Matters - Recap of Flights Case 3

Welcome to the Recap of the 3rd case in our Air Care and Mobile Care Flight Orientation Curriculum!

Approximately 1 month ago we presented and talked through a particularly challenging patient flight scenario.  As a refresher, if you don’t recall, check out the post here.  Following the posting of the case, I sat down with ACMC Medical Director Dr. Bill Hinckley and Resident Assistant Medical Director for Air Care, Dr. Andrew Latimer, and recorded a podcast with their reaction to the case and to some of the curveball scenarios posed in the question and discussion section.

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Pre-Hospital Stroke Care

Pre-Hospital Stroke Care

Pre-hospital stroke care begins with a quick, simple assessment tool used to help identify patients that are suffering a stroke.  In Southwest Ohio, this tool is the Cincinnati Pre-hospital Stroke Scale (CPSS).  There are three simple components of the CPSS – facial droop, arm drift, and slurred speech.  When assessing for facial droop, it is best to ask patients to bear their teeth.  Arm drift is assessed by asking the patient to hold both arms outstretched in front of them with their palms facing up.  If one arm drifts down or one hand rotates to a palm-down position, this aspect of the scale is positive.  Lastly, ask the patient to repeat a sentence to assess for slurred speech or any other type of speech abnormality.

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Grey Matters - Flights Case 3

Grey Matters - Flights Case 3

It is late on a blustery grey and rainy day in November and you are the dedicated flight doc on Air Care One (the “UH”) nearing the end of your shift. Your pilot has had to turn down two flights already due to high winds and reduced visibility as bands of storms moved through the area. Against your better judgment, you are standing in the sushi line in the hospital cafeteria to grab dinner when you hear “Air Care One Pilot, weather check for a patient coming back to the U” squawk out over your portable radio. Your excitement rises as “we can do that” echoes over the radio and you hear the tones drop for your flight. You grab the blood cooler and meet your crew for takeoff on the roof...

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Grand Rounds Recap March 30, 2016

Grand Rounds Recap March 30, 2016

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

 

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Annals of B-Pod: Acute Vision Loss

Annals of B-Pod: Acute Vision Loss

Thinking about the other left lower quadrant

 

The patient is a 74 year-old African-American female with a history of hypertension, coronary artery disease status post drug-eluting stent ×1, former cigarette smoker, and iron deficiency anemia presenting with left-sided vision loss. Patient states that approximately two days ago  she woke up with painless peripheral vision loss of her left eye only. She describes it as darkness in the lateral portion of her left eye. She  reports that her vision returned to baseline throughout that day; only to return when she awoke the next morning. Since that time she endorses persistent vision loss in the left periphery. She denies blurry vision, eye pain, headaches, recent trauma, flashes, and floaters. Furthermore, she also denies dizziness, numbness weakness, dysarthria, dysphagia, fever, chills nausea, vomiting, chest pain, shortness of breath, and palpitations. She reports adherence to her antihypertensive and anti-platelet medications...

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Grand Rounds Recap - 11/18

Grand Rounds Recap - 11/18

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.

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Grand Rounds Recap 8/26

Grand Rounds Recap 8/26

M&M with Dr. LaFollette

Case 1: Troponin Use in ESRD

  • Evaluating cardiac ischemia in ESRD patients can be difficult due to baseline troponin elevations. However, all is not lost...
  • Troponins can be used as a reliable marker of ischemia, even despite its collection in proximity to dialysis, if you take some things into account:
  • Studies vary widely on troponin levels during dialysis, consensus being that troponin levels do not vary significantly vary with dialysis.
  • Although the baseline may be abnormally elevated, ESRD patients nonetheless have a new baseline. Changes above this baseline and especially up trending troponins should trigger alarms that the patient may be having active ischemia.  
  • Troponin elevation in ESRD patients, even if at their baseline, is an independent risk factor for short term mortality
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