October 15, 2014

B Pod Case Reports: 22 Year Old with Difficulty Swallowing

October 15, 2014/ Ryan LaFollette, MD

Chief Complaint

Difficulty Swallowing

History of Present Illness

The patient is a 22 year old female with no significant past medical history who presents to the ED with a chief complaint of dysphagia. The patient first noticed difficulty swallowing solid foods 2 weeks ago. She states that she felt like food was getting caught in her throat. Initially she only had difficulty swallowing solid foods and was able to eat soft foods and liquids. However, she reports that over the course of two weeks her condition gradually worsened to the point where she could no longer tolerate fluids. She states that she has pain in the back of her throat when she attempts to swallow.

October 13, 2014

Annals of B Pod - Visual Dx

October 13, 2014/ Ryan LaFollette, MD

A 34 year old male presents to the ED complaining of swelling and pain after eating... What's your diagnosis and management?

October 11, 2014

Grand Rounds Recap - 10/8/2014

October 11, 2014/ Jeffery Hill, MD M.Ed

Quarterly Sim with Dr. Frank Fernandez

82yoF with multiple medical problems including Grave's Disease who accidentally stopped her Synthroid arrives altered, hypothermic, and bradycardic.

Differential diagnosis for profound hypothermia is fairly short: Environmental vs. Hypometabolism (sepsis is typically a mild hypothermia)

The typical myxedema coma precipitants are infection, medication changes, or cold weather
Sepsis + bradycardia, should make you think about hypothyroidism
Consider evaluating hypothyroid patients for other metabolic issues as they are often co-morbid, especially SIADH

October 09, 2014

Suction Assisted Laryngoscopy and Airway Decontamination with Jim DuCanto, MD

October 09, 2014/ Mike Steuerwald

Recently, one of our FOAMed friends came to visit the University of Cincinnati. Jim Ducanto is well known for his innovations and general wealth of airway management knowledge. One wonderful thing that Jim shared with us during his visit was an airway mannequin that he “modified” to be able to puke…yes…puke. Not sort of puke…but REALLY PUKE!! Here is what Jim has to say regarding the motivation for building the device as well as lessons we learned while doing it’s “beta-test”.

October 07, 2014

Ebola

October 07, 2014/ Tyler Winders, MD

Ebola. Synonymous with Terror, Class A Bioterrorism Agent Extraordinaire. The Republic of Guinea and surrounding countries are in the midst of the deadliest, most widespread outbreak ever. Death totals are rising every day, and each new death is a new record that with any luck will never be eclipsed.

To quote the man that discovered and named Ebola after a river in the Congolese jungle,

“Soap, gloves, isolating patients, not reusing needles and quarantining the contacts of the ill - in theory it should be very easy to contain Ebola”

- Peter Piot

October 04, 2014

Grand Rounds Recap - 10/1/2014

October 04, 2014/ Jeffery Hill, MD M.Ed

Consultant of the Month Series: Ear Emergencies with Dr. Golub

Auricular hematoma

Blood separates the cartilage from the perichondrium which supplies the blood-flow to the cartilage. This can lead to cartilaginous ischemia, infection, deformation (cauliflower ear). Treatment: I+D: make cuts parallel to natural lines in the helix to reduce visible scarring. Place a bolster to close the new potential space. Bolster stays for 7-10days. Keep on Keflex while bolster in place and f/u with ENT.

October 02, 2014

Neurologic Emergencies in the Air

October 02, 2014/ Jeffery Hill, MD M.Ed

Several months ago, I sat down and talked about the management of neurologic emergencies in the prehospital environment with Dr. Erin McDonough, an Emergency Physician and Neurointensivist who attends both in the ED and the Neurosciences ICU, and is a member of the Cincinnati Stroke Team. In the brief podcast found below and on iTunes, we covered a wide range of topics including blood pressure management in spontaneous ICH, aneurysmal SAH, and ischemic stroke and some of the more rare complications associated with tPA administration.

September 28, 2014

How to Read Hip and Pelvis X-Rays

September 28, 2014/ Jeffery Hill, MD M.Ed

As a continuation of our radiology lecture series, take a look at the excellent instructional modules created by Dr. Anita Goel, PGY-1 resident at the University of Cincinnati Department of Emergency Medicine residency training program. Dr. Goel takes us through the basic anatomy, the particular features of the many different views that can be obtained in hip and pelvis plain film radiography, and a systematic approach to reading these often complicated radiographs.

September 27, 2014

Grand Rounds Recap - 9/24/2014

September 27, 2014/ Jeffery Hill, MD M.Ed

Management of the GI bleed (a review of the Cochrane Reviews):

PPI drips have been shown to decrease the rate of rebleed in patients with known peoptic ulcers. It has not been shown to decrease mortality, hospital stay, transfusion need. It also has not been shown to be beneficial in the undifferentiated upper GI bleed and may have a trend toward harm.
Octreotide doesn't improve mortality but on average decreased transfusion requirement by 1/2u product.
Antibiotic coverage (treating for gut translocation with ceftriaxone) has been shown to have lowered mortality from infection and all-cause mortality.
Prophylactic intubation: 2 retrospective chart reviews came up with contrasting results on mortality outcome after intubating for prophylactic reasons (patient was protecting their airway).

September 25, 2014

Transfusion in Trauma: One Ratio to Rule them All??

September 25, 2014/ Jeffery Hill, MD M.Ed

A couple weeks back we met for the first journal club of the year in our residency. For this first session, we tackled the clinical conundrum of transfusion ratios in trauma. The question came from a brainstorming session with the PGY-1 and 2 residents, where the following PICO question was derived:

Patients: Victims of both blunt and penetrating trauma in need of blood transfusion as a part of the their initial resuscitation

Intervention: high plasma and platelet to PRBC ratio transfusion

Comparison: low plasma and platelet to PRBC ratio transfusion

Outcome: Mortality (in patient and 30 day mortality)

September 22, 2014

Grand Rounds Recap - 9/17/2014

September 22, 2014/ Jeffery Hill, MD M.Ed

Radiation in Pregnancy with Dr. Polsinelli

Radiation effects can be deterministic or stochastic.

Deterministic effects cause direct cell damage (radiation burns, teratogenicity, intrauterine death, genetic material damage). There is no evidence of teratogenicity in diagnostic testing radiation ranges (<50mGy). Genetic damage (causing effects in future generations) is theoretical and has not been reported. IUD is a concern, but on a population based scale there was no noted increase in incidence of fetal demise after large scale radiation event and this cannot be studied in vivo.
Stochastic effects increase the probability of developing cancer. There is no minimum threshold and increasing dose increases probability. Risk of cancer noted to be ~5% if exposed to 1Gy of radiation. (for comparison maternal radiation is: chest xray = 0.1mGy; CT abd/pelvis 10mGy)

September 19, 2014

SMACC E.V.O

September 19, 2014/ Jeffery Hill, MD M.Ed

You may have heard of a little get-together happening in Chicago June 23-26th, 2015. And by little get-together I, of course, mean the biggest baddest Social Media and Critical Care Conference in existence coming to the U.S of A for the very first time. If you haven't heard of the SMACC conference, take a look at their conference webpage - http://www.smacc.net.au

September 17, 2014

What is Global Health?

September 17, 2014/ Anand Selvam, MD

Welcome to Taming the SRU’s Global Health section, where our goals are to increase awareness of global health issues, discuss clinical and ethical cases, and develop opportunities for residents to participate in global health electives. We believe global health education is critical to well-rounded medical education. Global health electives (GHEs) often have a profound effect on participants at any level. One study found that 70% of students participating in GHEs subsequently entered primary care residencies or intended to work in resource-limited settings. (1) These experiences lead to enhanced clinical and communication skills, humanism, cultural competency, and understanding of alternative concepts of health and disease. GHEs help trainees foster a deeper understanding of the global collective and how one’s own health is uniquely connected to the rest of the world. (2)

September 14, 2014

Interpretation of Head CTs

September 14, 2014/ Jeffery Hill, MD M.Ed

In the video series below, PGY-1 resident, Dr. Gorder, leads us through the key aspects of CT head interpretation. Attention is paid to the development of a rigorous systematic approach to review and interpretation of head CTs to aid in the identification of blood, ischemia, mass, signs of increased ICP, as well as fracture. In the second video, the key anatomic features seen on head CT's are covered.

September 14, 2014

Radiation in Pregnancy

September 14, 2014/ Jeffery Hill, MD M.Ed

In the first of two posts preparing for Grand Rounds in the coming week, PGY-1 EM resident, Dr. Polsinelli, guides through the murky waters of radiation exposure during pregnancy. She offers a background on what radiation is, how it's measured, the effects of radiation on the fetus, and radiation doses associated with common diagnostic exams.

Blog

Chief Complaint

History of Present Illness

Quarterly Sim with Dr. Frank Fernandez

Consultant of the Month Series: Ear Emergencies with Dr. Golub

Auricular hematoma

Radiation in Pregnancy with Dr. Polsinelli

Taming the SRU

SRU (pronounced "shrew") = Shock Resuscitation Unit

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