Grand Rounds Recap 4.26.23
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Join us for a review of US in pregnancy by Dr. Frederick, Highs and Lows of residency with Dr. Comiskey, as well as reviews of in flight emergencies and high altitude emergencies
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Foot Injuries in the ED
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As an EM physician, it is important to have an understanding of the spectrum of foot injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive. Injuries discussed are shown in Image 1.
Read MoreTwisting and Turning - Ankle Injuries in the ED
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As an EM physician, it is important to have an understanding of the spectrum of ankle injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive.
Read MoreThe CLOVERS Trial
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Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. One of the primary pathophysiologic mechanisms involves complex cascade of host dysregulation in response to an infectious stimulus (Evans, Rhodes et al. 2021, Jarczak, Kluge et al. 2021). Recent meta-analyses and systematic reviews evaluating mortality in patients with septic shock reported mortality as high as 35% and 38% at 30 and 90 days, respectively (Vincent, Jones et al. 2019, Bauer, Gerlach et al. 2020). Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. 2022), ideally with antibiotics administered within one hour of sepsis recognition by the treating provider (Evans, Rhodes et al. 2021). Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al. 2022).
Read MoreGrand Rounds Recap 4.19.23
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This week we start off with Drs Davis and Paulsen in a CPC of an infected thyroglossal duct cyst. We then had two tox presentations on ethylene glycol poisoning as well as a trip through all those poisonous plants you knew once. Drs. Zalesky and Wosiski-Kuhn then take a trip around the latest research in EM!
Read MoreAcute Hyperthermia in the Emergency Department
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Often when we see elevated temperatures in the emergency department, our first instinct is to search for an infectious source. However, when body temperatures start exceeding 40.5 degrees, infection is a less likely etiology and there are a plethora of conditions that need to be considered.
Read MoreIV Metoprolol vs Diltiazem for A fib with RVR and Concomitant Heart Failure
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The management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction. The presence of HFrEF limits pharmacologic options for rate control. This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure
Read MoreFearsome Foliage - An Overview of Toxic Plants
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Spring has sprung... and so have many species of toxic plants! Poison centers across the United States receive over 100,000 reports of exposures to toxic plants annually. It is often difficult for Emergency Medicine providers to determine the quantity and time of exposure. Plant identification presents another challenge, and can even require the input of a botanist. Now that is an interesting consult! Thankfully, some of the more common and/or dangerous plant poisonings have been well-categorized, and are summarized in this post.
Read MoreGrand Rounds Recap 4.5.23
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This week we start off with Dr. Mullen’s lessons from morbidity and mortality conference. This is followed by R1 Dr. Vaishnav with a diagnostics talk on hyperthermia. Dr. Adan walks us through the always terrifying world of laryngectomy patients and finally guest lecturer Dr. Ray Bignall gives an excellent talk on disparities in medicine and how we address them
Read MoreGrand Rounds Recap 3.29.23
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We are back with an excellent grand rounds session, where we heard about a case of resuscitative hysterotomy from Dr. Stark, BRASH syndrome, and HIV screening in the ED. We also heard some life lessons from the Peace Corps and how they relate to emergency medicine.
Read MoreGrand Rounds Recap 3.15.23
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What a packed week! We reviewed a harrowing case of massive bee envenomation (with insects in the airway) w/ Dr. Yates, R4 wisdom and philosophies with Dr. Mullen, an overview of hydrocephalus with Dr. Stothers, a CPC of a brain tumor presenting with aphasia with Dr. Glenn, a dive into hyperviscosity syndromes with Dr. Beyde, and a wonderful series of lectures on the Language of Being Well & Embracing Fear in EM with visiting professor Dr. Arlene Chung.
Read MoreGrand Rounds Recap 3.8.23
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We are back with a special grand rounds with visiting professor Dr. Arun Nagdev discussing a variety of ultrasound guided nerve blocks in the ED, CPC with Drs. Harward and Roche, and a review of multiple etiologies and management of pediatric seizure with our CCHMC PEM colleagues.
Read MoreGrand Rounds Recap 2.15.23
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Check out this week’s MASSIVE recap with Dr. Connelly’s poignant lessons from her time with Sydney HEMS, Dr. Broadstock’s R4 case follow up of HIV myositis, Dr. De Castro’s extensive Vitamin deficient review, Small Groups on task saturation and ITE review and a Palliative Medicine lecture by dual trained Dr. Kiser.
Read MoreGrand Rounds Recap 2.1.23
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This week in Grand rounds, we had some case reflection from R4 Dr.Zalesky reminding us to avoid anchoring, be aware of our biases for or against patients, and avoid creating a rude work environment. Dr. Moulds and Dr. Goel had a CPC showdown with a case of Cecal Diverticulitis, while Dr. Artiga gave us the low down on Lung Ultrasound in the ED. We wrapped up the day with an R4 lead simulation on a case of Thyrotoxicosis.
Read MoreGrand Rounds Recap 2.8.23
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During Grand Rounds this week, we had the pleasure of hosting our Brian Gibler visiting lecturer Dr. John Deleda who Spoke about Henry Ford Hospitals COVID-19 response and the leadership lessons he learned over his career. Dr. Della Porta then gave us the rundown on different blood products and using TEG. We discussed PPROM, Breech delivery, and neonatal resuscitation with Dr. Crawford. The CPC showdown with Dr. Minges and Dr. Brower ended as a case of Hyperleukocystosis and Leukostasis. We ended the day with a talk from our PEM colleagues on inborn errors of metabolism.
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