Tamingthesru

Journal Club, Grand Rounds Jeffery Hill, MD M.Ed Journal Club, Grand Rounds Jeffery Hill, MD M.Ed

The Search for the Holy Grail: Assessment of Fluid Responsiveness

Last week our residents and faculty met for journal club in search of the holy grail.. err.. I mean, to talk about ways to assess volume responsiveness.  A couple of weeks back the PGY-1 and 2  residents met and discussed a number of questions they had about the care and management of patients with sepsis.  The discussion hit on a number of key topics: empiric antibiotic selection, timing of antibiotics, choice of vasopressors, etc.  Ultimately the group decided they wanted to take a closer look at non-invasive ways to assess volume responsiveness and guide resuscitation in septic patients.

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Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed

Approach to Reading MRI of the Spine

It's another back pain type of day in Minor Care.  3 hours into your shift and you've seen 6 patient's with back pain.  You quickly evaluate them asking them about red flag symptoms, searching for signs of neurologic injury on your physical exam.  As you talk to Jane, your next patient, you get worried she doesn't have simple musculo-ligamentous back pain.  Jane has a history of IVDU and states her last use was 3 months ago.  She cites some subjective fever and chills over the past several days along with aching low back pain which has been getting steadily worse.  On exam, you find she is febrile with a temperature of 101.4, tachycardic to 110, with a normal blood pressure.  She has midline upper lumbar and lower thoracic spinal tenderness to palpation.

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Grand Rounds Jeffery Hill, MD M.Ed Grand Rounds Jeffery Hill, MD M.Ed

Grand Rounds Recap - 1/21/15

Evidence-Based Emergency Medicine: Accidental Hypothermia with Drs. Mudd & Riddle

Grading the Severity of Hypothermia

  • Mild hypothermia is defined as 32-35 °C and symptoms include confusion and diuresis
  • Moderate hypothermia occurs from 28-31°C and is associated with lack of shivering, atrial arrhythmias, and worsening changes in mental status (including paradoxical undressing)
  • Severe hypothermia happens when core body temperature is less then 28 °C and is associated with coma, significant decreases in metabolism, and a very low threshold for V-fib
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