Tamingthesru

The Water Cooler Tim Loftus, MD The Water Cooler Tim Loftus, MD

Pre-Ox, Ap-Ox, and NO DESAT - Water Cooler Rundown

In 2012 in the Annals of Emergency Medicine, Weingart and Levitan published a review of preoxygenation and peri-intubation oxygenation techniques in the emergency airway management of adult patients.  Topics reviewed included the evidentiary support for preoxygenation and denitrogenation, appropriate positioning and patient selection, the utility of positive pressure in select circumstances, apneic oxygenation, as well as a proposed risk stratification approach based on pulse oximetry levels and peri-intubation risk.

A great discussion was had with many excellent learning points, upon which some were elaborated in great detail in the article and some only briefly mentioned.  What follows is a brief summary of learning points from the article as well as from the discussion. 

Read More
Jeffery Hill, MD M.Ed Jeffery Hill, MD M.Ed

Grand Rounds Recap - 8/27/2014

Botulism

  • Caused by neurotoxin produced by Clostridium bacteria
  • 3 types: food borne, infant and wound
  • Pathophysiology: toxin binds to cholinergic cells and prevents release of acetylcholine
  • Symptoms
    • Foodborne illness starts with N, V and D. Similar to gastroenteritis
    • Neurologic symptoms: fixed and dilated pupils, ophthalmoplegia, ptosis,       bilateral and symmetric facial paralysis that progresses to limbs and trunk, respiratory muscle weakness
    • Patients frequently complain of dysphagia, dry mouth and other anticholinegric symptoms
  • Infant botulism = floppy baby who is weak, has a weak cry, constipation and does not feed well
  • Botulism is easily confused with myasthenia gravis and Miller Fischer variant of Guillan Barre
  • Diagnosis: clinical in the ED
    • Tensilon test is normal but is helpful in diagnosing myasthenia
    • EMG may be abnormal
Read More
Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed

The Approach to Abdominal X-rays

Utility of the imaging modality aside, abdominal radiographs can be a bit of a challenge to interpret.  With a number of possible techniques (cross table laterals, left lateral decubitus, AP, upright, or supine) and a lot of structures to evaluate (is that small bowel or large bowel?, is that a kidney stone or an infamous phlebolith?), it's pretty easy to stare at a film and zone out as you eye moves from one shade of gray to another.

In the embedded video below, PGY-1 resident, Dr. Julie Teuber goes through a standardized approach to reading the abdominal x-ray that hopefully help keep your eyes from going cross-eyed next time you need to interpret an acute abdominal series.

Read More