Grand Rounds Recap 4.29.20

Grand Rounds Recap 4.29.20

Another fantastic week of video conferencing started with Dr. Ham’s Morbidity and Mortality presentation through an array of zebras seen in our ED, Dr Ramsey discussed ED use of ocular ultrasound, Drs Adan and Connelly faced off in CPC case of retroviral syndrome and Dr Harty’s capstone detailed cases of pediatric patients which will prep any new parent.

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Grand Rounds Recap 4.22.20

Grand Rounds Recap 4.22.20

Another great week of Grand Rounds started with a journal club on pediatric resuscitation (podcast inbound soon), followed by a new electrolyte protocol via QI/KT with Drs Gawron and Hassani. Dr. Jensen’s TamingtheSRU lecture highlights a complex combination drug overdose and Dr. Garber gives an update on the pharamcotherapies of COVID. Finally Drs. Leech and Hill trialed the first remote simulation on post partum hemorrhage.

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Grand Rounds Recap 5/4

Grand Rounds Recap 5/4

Acetaminophen Toxicity Sim - Drs. LaFollette, Nelson and Toth

Take a read through our Cases If It Bleeds it Leads..., Seeing is Believing..., and Belly Pain Bonanza. Curated commentary to follow

Acetaminophen Toxicity

  • 60,000 poisonings / year
  • ~500 deaths per year, evenly split therapeutic / suicide
  • Mechanism - acetaminophen to NAPQI by P450, overwhelming gluthathione stores
  • Alcohol, phenytoin, isoniazid all induce P450 and may increase NAPQI production. Chronic alcohol use will worsen toxicity when acute ingestion will competitively inhibit and can be preventative at producing the toxic metabolite
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Grand Rounds Recap - 10/22/14

Grand Rounds Recap - 10/22/14

Acetaminophen can be one of the most dangerous drugs in overdose, as the toxic dose of acetaminophen is 250 mg/kg

There are 4 stages of acetaminophen overdose:

  • Stage 1 from 0-24 hours when labs may be normal but the patient has nonspecific symptoms such as nausea, vomiting, and fatigue
  • Stage 2 from 24-72 hours when labs may be normal or be trending upward but the patient is asymptomatic
  • Stage 3 from 72-96 hours when significant metabolic derangement can occur such as profound metabolic acidosis, florid liver failure, and AKI.
  • Stage 4 takes place only if you are able to get them through the acute illness precipitated in Stage 3 when hopefully recovery takes place, though there is no guarantee of liver recovery
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