Diagnostics: Ophthalmologic Trauma
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Dr. Pawlik walks us in depth through the evaluation, diagnosis and management of traumatic injuries to the eye.
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What is Clinical Informatics Anyway?
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When I began my clinical informatics elective I planned to spend my time taking online courses on how to improve my Epic efficiency. After a day or so of online sessions I realized that (a) I’m already an Epic master (sort of) and (b) I hoped there was more to “clinical informatics” than faster documentation. So let’s begin at the beginning: what is clinical informatics?
Read MoreAvoiding Hypoxemia During Intubation
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More than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In this breakdown of a Journal Club article, Dr de Castro will cover a recent paper comparing NIPPV to oxygen mask only during preoxygenation for intubation.
Read MoreIntern Core Content: Disorders of the Adrenal Glands
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Join Dr Haupt as she discusses the adrenal glands, their role in hormone production and other functions throughout the body, and common problems that can occur when the adrenal glands are not working properly. Although most of these issues are non emergent problems, occasionally they will be seen in some sort of acute adrenal crisis in the emergency department and ER physicians should be well versed in their often subtle presentations!
Read MoreIs Hyperoxemia in Trauma Bad?
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Severe trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxemia. Emerging studies in the intensive care unit (ICU) setting suggest that liberal supplemental oxygen therapy and hyperoxemia is associated with increased mortality. Limited evidence in the trauma population suggests similar outcomes.
Read MoreA D-Dimer for Patients with High Pre-Test Probability of PE?
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We know that the d-dimer can be a helpful test for patients who have a low pre-test probability of pulmonary embolism. But can the test be pushed into use for higher risk patients? Will it still have useful negative predictive value or will we risk missing too many PEs?
Read MoreDiagnostics: Bariatric Surgery Complications
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Dr. Guay walks us through pathology unique to patients with a history of bariatric surgery. From surgical complications to vitamin deficiencies, there is a lot to consider in the care of this population.
Read MoreBridging the Gap: Efforts to Address Medicaid Coverage Gaps and Reentry Issues After Incarceration
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Often the ED is the source of routine care after incarceration, and that is often secondary to issues with medicaid lapsing during incarceration and dropping a key linkage to care. Join Dr. Kate Gallen as she examines why this can happen as the first step to improving the system is knowing where it fails.
Read MoreCan a Nitro Slurry Fix a Food Bolus Impaction?
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Esophageal food impaction (EFI) occurs at an estimated rate of 13 episodes per 100,000 people annually. Medical management is typically attempted before resorting to endoscopy to reduce procedural risks and resource use. Glucagon remains the most widely used medication. Other treatments include carbonated beverages, benzodiazepines, and, more recently, nitroglycerin. Despite glucagon being the most commonly used agent, its supporting data are limited to small studies or case reports. One older study showing over 60% efficacy lacked a comparator group and had multiple confounders. Another study suggested only minimal benefit and significant adverse effects—up to 50% vomiting—highlighting the need for better treatment options.
Read MoreDiagnostics and Therapeutics: Inhalation Injuries
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Dr Boggust walks us through the most important considerations for patients who present to the Emergency Department with inhalation injuries from smoke and other noxious chemicals.
Read MoreDiagnostics and Therapeutics: Tumor Lysis Syndrome
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Tumor lysis syndrome (TLS) is rare disease presentation in the emergency department that is very important to learn to diagnose and treat due to the high associated mortality, often quoted at 20% or more. This post discussed the pathophysiology of the disease process, as well as how to appropriate identify and treat TLS in a timely manner to prevent complications such as cardiac dysrhythmias and acute renal failure.
Read MoreGrand Rounds Recap 12.11.24
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Another week, another great Grand Rounds! First, Dr. Lang takes us through the evidence behind our common treatment of low back pain. Next, Drs. Boyer and Segev give us a evidence guided management of the acutely ischemic limb. Next, Dr. Hajdu takes us through a difficult case of cardiac arrest in the ED. Finally, we learn all about infections of the pelvis and perineum with Dr. Guay!
Read MoreBreath Easy: Navigating Asthma and COPD Exacerbations
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Not all breathing is made equal, and a lot of it wheezes in the world of Emergency Medicine. Join Dr. Blaine Oldham as he reviews asthma and COPD and how to approach each with some nuance
Read MoreSerotonin Syndrome & NMS
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It can be a challenge to differentiate NMS and Serotonin syndrome, careful attention to historical factors, a thorough medication history, and a detailed physical exam and neurologic exam is necessary to quickly diagnose these patients. This post details the presentation of each entity and highlights the differences between the two.
Read MoreBut Can You Just PO?
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Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causes—some requiring IV fluid resuscitation and others requiring none. Considering the nationwide IV fluid shortage, judicious use of fluids is imperative. Thus, this begs the question, who really needs IV fluids, and can the patient simply hydrate orally? This article serves to briefly discuss IV fluids administration in the ED and the instances where they are not indicated.
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