May 02, 2015

Grand Rounds Recap - 4/29/15

May 02, 2015/ Jeffery Hill, MD M.Ed

Morbidity and Mortality Conference with Dr. Stull

1. Pericardiocentesis tips and tricks

Your needle should be at a 45 degree angle when entering the chest at the xyphoid process, aim to the L shoulder/scapula
Use a spinal needle and keep the stylet in while entering the skin in order to prevent needle clogging
Keep head of bed at 30 degrees to encourage the fluid to drain inferiorly
Can attach an EKG lead to the needle by an alligator clip. You will get an ST elevation in that lead if you hit the myocardium
Can use an A.line kit to place a catheter into the pericardium for continuous drainage
US probe position: subxyphoid
How to Video on TamingtheSRU - http://www.tamingthesru.com/blog/acmc/pericardiocentesis

April 30, 2015

Field Amputation

April 30, 2015/ Andrew Latimer, MD

Hey, everybody! Today we are going to talk about field limb amputation.

I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life.

First, let’s provide a little background on the pre-hospital limb amputation. The procedure itself has gained much more press in the FOAMed world and the emergency medicine and pre-hospital literature since the 2010 earthquake in Haiti during which early physician responders were faced with large numbers of patients trapped under debris and few responders with familiarity or basic working knowledge of the procedure (Lorich et al, 2010). A few of case reports and articles surfaced around this time and the field amp even made an appearance in an episode of the popular television show ‘Greys Anatomy’ in 2011.

So I was told…

April 27, 2015

Flights - A Pain in My Heart

April 27, 2015/ Jeffery Hill, MD M.Ed

You are the Pod doc overnight on a particularly quiet Sunday night. You have been looking for an excuse to leave the pod and do anything other than treat abdominal pain for the past several hours when the tones drop. You thank whatever celestial being you believe in and grab the blood and run out of the department full of glee. In route to the helipad you are told it is a Code STEMI. At this point, even that seems more interesting than sitting in C Pod.

You buckle into the helicopter and take a quick flight to the outside hospital. You grab a set of gloves and unload the cot carefully and walk inside.

April 25, 2015

Grand Rounds Recap - 4/22/15

April 25, 2015/ Jeffery Hill, MD M.Ed

Oral Boards Practice Cases

Case 1 - 22 yo F in a "coma" with normal vital signs. Not responding to Narcan and Dextrose. Found in a garage. On exam, she has sluggish and dilated pupils. pH 6.98, pCO2 29, bicarb 2

High concern for toxic alcohol ingestion: consult DPIC and nephrology for dialysis

Fomepizole is the antidote for ethylene glycol only
Can use ethanol drip to treat both ethylene glycol and methanol
Replace folate aggressively and early
Methanol is metabolized to formic acid, if you give folate you can prevent methanol from going down the formic acid pathway

April 23, 2015

Annals of B-Pod Spring Issue

April 23, 2015/ Jeffery Hill, MD M.Ed

The Spring Issue of Annals of B-Pod is hot off the presses!

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.

April 20, 2015

Flights - A Blow to the Head Recap and Expert Commentary

April 20, 2015/ Jeffery Hill, MD M.Ed

Thanks 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!

What medications could be used in the care of this patient? If the patient loses his IV, how does your treatment strategy change?

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.

April 17, 2015

Grand Rounds Recap - 4/15/15

April 17, 2015/ Jeffery Hill, MD M.Ed

Ocular Emergencies with Dr. Titone

Blood 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

April 12, 2015

Grand Rounds Recap - 4/8/15

April 12, 2015/ Jeffery Hill, MD M.Ed

AirCare Grand Rounds

1. Indications for T pod

Blunt trauma + unstable pelvis
Blunt trauma + shock + pelvic tenderness to compression
Blunt trauma + shock + AMS/inability to evaluate pelvic pain

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)

April 09, 2015

The Cognitive Autopsy

April 09, 2015/ Jeffery Hill, MD M.Ed

We 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…

April 06, 2015

Vascular Ultrasound - Aorta & Lower Extremity Veins

April 06, 2015/ Jeffery Hill, MD M.Ed

It'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...

March 30, 2015

Flights - A Blow to the Head

March 30, 2015/ Jeffery Hill, MD M.Ed

You’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

March 29, 2015

Grand Rounds Recap - 3/25/15

March 29, 2015/ Jeffery Hill, MD M.Ed

Mortality & Morbidity Conference with Dr. Bohanske

Remember that sometimes the thing a patient needs most is a specialist (i.e surgeon), especially trauma patients

Sharps in hectic situations, such as any resuscitation, are dangerous not just for the patient but also for providers as this is one of the most common situations leading to bloodborne pathogen exposures
Remove sharps from the field anytime you do not need them and always be responsible for your own sharps to keep your team safe
Keep in mind that early predicators of hemorrhagic shock are pulse and mental status/anxiety as BP changes are later indicators

March 26, 2015

Laryngoscopy - A Definition of Terms

March 26, 2015/ Guest User

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.

March 24, 2015

Flights - A Stab in the Dark - Curated Comments and Expert Commentary

March 24, 2015/ Jeffery Hill, MD M.Ed

Thanks 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

Q1 - Walk through your initial assessment of this patient. What are the critical aspects of the assessment of this patient?

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.

Blog

Morbidity and Mortality Conference with Dr. Stull

Oral Boards Practice Cases

The Spring Issue of Annals of B-Pod is hot off the presses!

What medications could be used in the care of this patient? If the patient loses his IV, how does your treatment strategy change?

Ocular Emergencies with Dr. Titone

AirCare Grand Rounds

Mortality & Morbidity Conference with Dr. Bohanske

Q1 - Walk through your initial assessment of this patient. What are the critical aspects of the assessment of this patient?

Evidence-Based Emergency Medicine: Vent Management with Drs. Axelson & Scupp

Taming the SRU

SRU (pronounced "shrew") = Shock Resuscitation Unit

Categories

Links

Some Helpful Foam

Tags