Who gets antibiotics in COPD? Does that back pain patient have discitis? What causes pancytopenia anyhow? Answers to these questions and so many more in this months issue of Annals of B-Pod. Click on the image below for the full pdf.
Read MoreThanks to everybody who commented and contributed to the discussion on our last "Flight!" If you missed out on the case, check it out here. We had a great discussion which we have recapped here. Take a look below and a listen to the commentary provided by Dr. Bill Hinckley in the embedded podcast. Look for our next flight to lift off in the next couple of weeks!
This first question sparked quite a bit of debate within the community. Everybody agreed that this patient requires sedation, intubation, and more sedation. There was, however, some significant differences in how the providers would go about attaining adequate sedation.
Read MoreBlood supply to the eye is from the Internal Carotid and drainage is through cavernous sinus. Bony eye septum is an improtant structure that separates the superficial structures from the deeper structures that have direct communications with the brain.
Key historical factors: recent eye procedures, eye drop use, contact lens use, occupational history, UV ligh exposure
Read More1. Indications for T pod
In patients with blunt trauma who are in shock and have AMS, incidence of pelvic fractures is 10%. In patients who die of blunt trauma during transport, open book pelvis fracture is the #1 cause of death (according to our own QI data)
Read MoreWe are in a thinking profession.
An outsider looking in on our profession may see procedures and action as the defining characteristics of the practice of Emergency Medicine. But, reflecting on the attributes of the best EM docs I’ve worked with, their procedural excellence isn’t what stands out. Thinking back on the great physicians I have met and worked with, the ones I strive to be like every day, it is their ability to think, lead, and educate that sticks with me the most.
And, it turns out I’m not the only one who might see it like this…
Read MoreIt's a frosty Easter morning and the ED is "q!&%t," all except for the 2 patient's turned over to you by the night ranger. You greet the first patient, a 75 yo M complaining of flank pain - probably a kidney stone you think to yourself as you walk in to the room. Walking into the room, you see the patient rolling around on the stretcher (as one would expect from those with a stone jammed in the UVJ), but something about his presentation strikes you as odd - a bit of diaphoresis, clammy pale skin. It could just be pain, but the specter of a ruptured abdominal aortic aneurysm still looms large in your differential diagnosis. You quickly exit the room, grab the ultrasound machine and head back in to take a look at his aorta...
Read MoreYou’re working as the Pod-Doc, having just taken the radio from the off-going UH-doc, you just finish admitting the patient in C40 for NSTEMI when the tones go off.
“Air Care 1 and Pod Doc respond to a scene for motorcycle crash, Northern Kentucky”
You call the B-Pod attending, sign out the pod, grab the blood from the blood cooler and head to the helipad. Flying over the river, landing at a local firehouse’s parking lot you hop out of the back of the helicopter and head to the awaiting squad.
Your patient is a 29 year-old male who was riding his motorcycle (without a helmet) on a local country road. Coming around a blind corner he unexpectedly found a car stopped in the middle of the road. Striking the car from behind at ~35mph, he flew over the handlebars and impacted the back of the car.
On EMS’s arrival he was initially unconscious, but since their arrival has become increasingly combative
Read MoreRemember that sometimes the thing a patient needs most is a specialist (i.e surgeon), especially trauma patients
There can be some confusion with regards to the terminology surrounding laryngoscopy. The term "video laryngoscopy" can be used imprecisely without specific attention paid to the geometry of the blade containing the video camera. The geometry of the blade, however, is crucially important as the biomechanics of laryngoscopy differ substantially depending on whether a standard geometry (Macintosh or Miller) blade or a hyperangulated blade is used. Below you will find specific definition of terms with regards to laryngoscopy and a video demonstrating the differences between direct laryngoscopy, standard geometry video laryngoscopy, and hyperangulated video laryngoscopy.
Read MoreThanks to everybody who contributed to an excellent discussion of the care of the patient on our second “flight.” If you didn’t get a chance to check out the case and the discussion, check it out here. Below is the curated comments from the community and a podcast from Dr. Hinckley and Flight Nurse Practitioner Jason Peng
In response to this question, most everybody wanted to first act on the bleeding wound in the patient’s right antecubital fossa. As explained by Dr. Renne, “I would want to be systematic but efficient, probably using a C-ABCD approach to these kind of critical patients, with the first C being any sort of life-threatening but "C"ontrollable hemorrhage.” Dr. Renne also had a fine point with regards to checking for other potential, as of yet unseen, injuries. This is a patient with multiple stab wounds, it is crucial to conduct a quick, but thorough search for stab wounds to the back, axilla, groin, and/or other locations where significant blood loss could be caused by a stab wound.
Read MoreThe term Acute Lung Injury (ALI) is being phased out and instead Acute Respiratory Distress Syndrome (ARDS) is now graded mild, moderate, and severe depending on the PaO2:FiO2 ratio
The median onset of ARDS after presentation to the ED was 2 day but could be anywhere from 5 hours to 5 days
ARDS Net was a foundational trial in ventilator management and was a triall of tidal volume and plateau pressures. The primary end point, mortality, was reduced by >20% when folks were on a low TV (6cc/kg) and lower PP (25-30 mm Hg).
Read MoreThere is a well established distrust of the medical system by minorities, especially African Americans. The historic causes of this distrust are widespread and seen in nearly all stages of American Healthcare. A great resource is Medical Apartheid by Harriet Washington. Some key examples of the use of AA in medical advances:
1800s: Slaves referred to as "clinical material" in medical schools and journal publications. Slave bought and used for experiments and experimental surgeries including the first successful vesicovaginal fistula repair (caused by forcep deliveries) which was done without anesthesia.
1900-1930: "malaria therapy" with fatal falciparum used to try and treat syphilis. Tuskeegee experiments- subjects recruited under false pretense of "free testing and medical treatment" for syphilis experiment with no intention to treat despite PCN being widely available. "The future of the negro lies in the research laboratory..." Patients were offered a free burial when they died from the disease so that an autopsy may be performed. "as I see it, we have no further interest in these patients until they die..."
Read MoreThe soft-tissue neck radiograph can be an extremely useful tool in a variety of clinical situations. These include: epiglottitis, croup, retropharyngeal abscesses, and localization of airway foreign bodies.
However, like any diagnostic tool, the soft tissue neck x-ray’s usefulness depends on knowledge of the relevant anatomy — particularly the normal size and appearance of various airway structures — as well as a systematic approach to each radiograph. We will discuss both the anatomy and radiographic approach in this blog post.
Read MoreOften times during the EMS continuing education courses we teach, we get questions about recertification requirements for both our state and National Registry certifications. This podcast is designed to summarize the various recertification requirements as well as discuss the National Registry Transition from EMT-Paramedic to Paramedic. While much of the discussion focuses on these issues relating to Paramedic certifications, the same principles can be applied to recertification requirements for other levels of pre-hospital providers. For a complete set of recertification requirements we refer Ohio providers to the Ohio EMS website: ems.ohio.gov. For details about the National Registry’s requirements for re-certification, we refer everyone to their website: nremt.org.
Read MoreYou are working overnight as the H2 doc based at Butler County Regional Airport. It’s bitter cold out (for Ohio that is). Its only 11 PM and already the temperature has dropped to 9 degrees fahrenheit on its way to a low of 0. You are in the lounge refamiliarizing yourself with the contents of the critical care cells when the tones go off: “Scene: stab wound – Hamilton Ohio”
You and the nurse grab your equipment, the blood cooler, and head to the helicopter. You put the critical care cells back in their spot in the rear of the helicopter and then buckle in for the short flight to the scene.
Your patient is a 23 year-old female who was in an argument with her boyfriend earlier in the evening. The verbal argument quickly escalated, her boyfrienf pulling a knife and stabbing her multiple times in the right arm and right chest. He fled the scene and she managed to call 911. The first responders found the patient with significant active bleeding from her arm as well as chest. She was initially responsive, but is now only awake to painful stimuli.
You meet the EMS crew in the back of the squad truck and assess the patient from the head of the bed.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
