Tamingthesru
Grand Rounds Recap 1.2.19
We had an excellent series of lectures this week at our Grand Rounds to welcome in the New Year! The esteemed Drs. Calhoun and Stettler started us off with our Great Debate series pitting Ketofol against Ketamine or Propofol alone for procedural sedation. The winner of this debate? Definitely the audience who got to soak up the expertise from these clinical giants. Next up was Dr. Leenellett who guided us through some community ED cases of early pregnancy vaginal bleeding in our Discharge, Transfer, or Treat lecture series. Dr. Laurence then led us through a small group case based discussion on the indications for massive transfusions in trauma. Then a hush fell over the crowd as Dr. Iparraguierre laid down the CPC gauntlet with a presentation of Myasthenia Gravis for Dr. LaFollete who masterfully identified the Ice Pack Test as the diagnostic test of choice! Next up was Dr. Colmer who gave some tips for the management of severe alcohol withdrawal with his case follow-up lecture. There was no knocking this knowledge train off the tracks as Dr. Urbanowicz led us through a harrowing discussion on Weapons of Mass Destruction. To round out the day Drs. Klaszky, Gauger, and Murphy Crews led us through some small group exercises on the NIH stroke scale, CT angiography of the head and neck interpretation, neurological emergencies jeopardy, and indications for performing a burr hole with some hands on practice (simulation of course!).
Grand Rounds Recap 12.19.18
Come check-out our Grand Rounds Summary for 12.19.18! We started the morning with some fascinating cases in Morbidity and Mortality Conference with Dr. Baez. Next, we learned the importance and efficacy of mindfulness with Dr. Bernardoni. Dr. Makinen and Dr. Curry went head-to-head on a Clinical Pathologic Conference about a patient with hyperthermia due to sympathomimetic overdose. Lastly, Dr. Frederick taught us the evidence behind PECARN!
To Scan or Not to Scan? PECARN for Pediatric Head Trauma.
When a child comes in to the emergency department for head trauma, it can be difficult to balance unwanted, and possibly unnecessary radiation, with the risk of missing clinically significant head trauma. CT scans of the head allow providers to rapidly identify, and subsequently address dangerous and potentially life-threatening intracranial trauma and hemorrhages. However, as with everything in medicine, a CT scan is not without risks, particularly in the pediatric patient. With over 500,000 ED visits per year dedicated to pediatric head traumas, this is a challenge that emergency medicine providers face frequently (1). A study published in 2001 suggests that approximately 170 deaths were attributable to one year of CT head examinations in pediatric patients (2), and utilization of CT imaging has only increased since. Therefore, as with any radiation based imaging, careful consideration should be given to whether the test is truly necessary. As mechanism of injury and post-trauma symptoms can range drastically, it can be difficult to accurately assess the appropriateness of imaging in a child. As such, the pediatric emergency care applied research network (PECARN) worked to develop a clinical decision tool to guide clinicians in the need for head CT following pediatric head trauma.