Clearance of cervical spine is more within the house of Emergency Medicine than anywhere else, so it implores that when we clear a cervical spine using our rules, we take a second to consider the sensitivity, specificity and even more importantly the exclusions that were used in the derivation and validations in these studies. Dr. Gawron takes a look through these rules for our reviewRead More
It was an exciting week of Grand Rounds! We had the honor of hearing from legendary UCEM graduate Dr. Susan Stern who was the Dr. Gibler Visiting Professor. She discussed hemorrhage in trauma and the changing landscape of leadership in medicine. This was followed by operations updates with Dr. Palmer, and Dr. Laurence discussed AIDS-defining illnesses in her clinical knowledge lecture. The day concluded with a review of some Air Care cases. Check it out!Read More
Massive Transfusion (MT) is a life-saving trigger in trauma centers, but heavy is the burden of activating significant resources without knowing the blood products will go to good use. The ABC is the ACS recommendation, is easy and requires no additional testing, however newer weighted scores like PWH and TASH have showed promise in external validations. This week, Dr. Laurence takes a deep dive into the literature behind these triggers, their validation as well as some take aways for your use of life-saving Massive Transfusion.Read More
It's late into your shift when a 12 month-old rolls into your trauma bay and have reproducible abdominal pain. Do you go straight to CT? LFTs? UA? Dr. Shan Modi takes us through the literature and utility of laboratory studies and EKGs in pediatric trauma.Read More
This week, we started things off with a great Quarterly Sim led by our faculty. The oral boards cases, led by Drs Stettler and Roche, involved an acute presentation of holiday heart, a post-partum patient with flash pulmonary edema, and a very questionable spider bite. The simulation, led by Drs Fernandez, Hill and Stolz, focused on two patients that were in shock: one due to a ruptured ectopic pregnancy and one due to a pericardial tamponade. We then moved on to the pediatric side of things, where Dr. Gleimer discussed neonatal rashes, and we took a look at pediatric syncope with Dr. Fananapazir.Read More
In this week's Grand Rounds, Dr. McDonough spearheaded a discussion of the art of breaking bad news in the Emergency Department. Drs Dang, Renne and Teuber led us through a focused management of obstetric emergencies: placental abruption, difficult deliveries and the pregnant traumatic arrest patient.Read More
This week, Dr. Carleton talks logistics, tips and tricks of lower extremity regional anesthesia. We had a sim on the challenges of afib control in the hypotensive patient, reviewed rare trauma populations in oral boards and Dr Richardson discussed hospice and palliative care in the ED.Read More
This week included our first every chalk-talk about antibiotics focusing on beta-lactams. We had our quarterly AirCare grand rounds where we learned about some special tools we carry on the aircraft including point of care lab testing and specialized suction devices. We also did a high fidelity hemorrhagic shock simulation. In two case follow-ups we learned about some special considerations in ACS and for pregnant patients in trauma. Read on!Read More
Early in the morning, you begin your day in your local emergency department. After getting yourself situated, a slow trickle of patients begin to appear on the board. It appears to be a normal morning, all except for the fact that five patients appear, one after the other, who have the same chief complaint: “Knee pain”. It is a good thing you brushed up on reading knee x-rays recently!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. Jay Johannigman, Chief of the Division of Trauma and Critical Care at the University of Cincinnati. Dr. Johannigman has over thirty years of military experience which includes 6 deployments to Iraq and Afghanistan. Dr. Johannigman joined us to discuss how the military experience has changed civilian trauma care in the United States.Read More
Quarterly Simulation and Oral Boards
How do you approach the undifferentiated patient in arrest?
- Your demographics and any initial history can differentiate the hyperkalemic arrest from recent chemo from the rhabdo from prolonged down time from overdose, etc.
Running a code is an art and a science
- Mental modeling is something that causes us angst but it works. Close your loop with your drugs and plan. Being loud with your summary reasserts your control of the situation and can quell the peanut gallery.
- Assign your roles and know your nurses and medics, introducing yourself mid-compressions is poor form and can decrease code efficiency
- We like to keep our fingers on the femoral pulse. It decreases pulse check time, let's you dictate timely next moves.
Evidence-Based Emergency Medicine: Accidental Hypothermia with Drs. Mudd & Riddle
Grading the Severity of Hypothermia
- Mild hypothermia is defined as 32-35 °C and symptoms include confusion and diuresis
- Moderate hypothermia occurs from 28-31°C and is associated with lack of shivering, atrial arrhythmias, and worsening changes in mental status (including paradoxical undressing)
- Severe hypothermia happens when core body temperature is less then 28 °C and is associated with coma, significant decreases in metabolism, and a very low threshold for V-fib