You’ve heard it many times, but does the old adage to “count your blessings” really help? During difficult times, it can seem as if nothing is going right. It feels like human nature to dwell on the negative, while reliving bad memories or experiences over and over in our minds.
Read MoreViral hepatitis is a commonly encountered and increasing problem thanks in part to the rise in injection drug use. Here I review the screening recommendations and interpretation of hepatitis B and C serology. Screening recommendations are based on CDC and US Preventative Task Force guidelines. Prevalence of viral hepatitis is much higher in the ED setting and may warrant expanded screening. This is an active area of research and there are as of yet no formal professional recommendations regarding expanded screening. In this post we will explore the current screening recommendations for HBV and HCV and detail the interpretation of the test findings.
Read MoreWe had another great week at Grand Rounds to wrap up the month of October. Dr. Betham ran the gamut of medical knowledge in her M&M, teaching us from organophosphate poisoning to rhabdomyolysis. Drs. Merriam and Curry battled in a CPC about submassive and massive PE. Dr. Shewakramani taught us about all things dental and Dr. Scupp brought it home with his soapbox about the importance of balance in IV fluid resuscitation.
Read MoreWe’re back again this week to discuss more about the initial approach to the MVC patient in B-pod. Last week we discussed occult bowel injury in the setting of blunt abdominal trauma. In the second episode of this topic, Dr. Powell also highlights the importance of an appropriate pain medication selection upon discharge from the emergency department, citing the importance to consciously avoid cavalier prescription of potentially habit-forming pain medications. But what kind of risk is involved when we send patients home with opioid prescriptions? Are they destined to seek out more?
Read MoreYou just got done with the most precarious of intubations, but while patting yourself on the back, you note that beeping saturation tone is continuing its decline. Did the tube get dislodged? Was it ever in the cords? Take a step into the plight of oxygen and pulse oximetry with our physiologic guru Dr Steve Carleton
Read MoreCheck out this week's Grand Rounds Recap where we reviewed coagulation studies and joint fluid analysis, learned about torsades, asthma, bronchiolitis, the perils of anesthetics in LAST and more!
Read MoreCertain pathology gets a lot of attention in medical school. Stroke? Sure! Tests love asking about which vessel is blocked based on clues from the physical exam. And rightly so; a fund of medical knowledge is certainly valuable when it comes to identifying pathology such as this. However, when faced with a problem like blunt trauma, i.e. the “MVC”, one may find that there are also many practical and logistical factors that require bedside experience, ranging from marshaling of resources to reconciling patient presentation with reported mechanism of injury...
Read MoreAll bleeding stops eventually... Even in your anticoagulated patients? What about that INR of 1.4? On rivaroxaban? To better know the state of anticoagulation we first must understand the tests we use to define them. Take a dive with Dr. Murphy-Crews through our anticoagulation studies
Read MoreNot all swollen joints are the same and our dogmatic definitions of septic joints are changing with each new study, so how do we use synovial fluid to define our differential of the swollen joint? Join Dr. Harty in delving through the latest in synovial fluid studies in his asynchronous intern diagnostics post on joint fluid analysis.
Read MoreThis week we had a Grand Rounds jam packed with clinical knowledge. When was the last time you considered the differential diagnosis of an elevated troponin? It's not just ACS! Read on to learn more about thyroid storm, refractory Vfib and Vtach, lithium toxicity, inflammatory markers, and more. As well as a special clinical soapbox about how Ohio became the epicenter of the nation's heroin epidemic.
Read MoreLast week we had our first Journal Club of the year and had an excellent discussion of the evidence surrounding the use of amiodarone, lidocaine, and procainamide for ventricular dysrhythmias. Take a listen to the podcast below and read up on the details of the papers below that!
Read MoreWorking in the ED one day you seem to hit a run of patients in whom consultants have asked you to order an ESR, CRP. First, podiatry asked for them for a patient with 1st metatarsal osteomyelitis. Spine surgery wanted the same for a patient with diskitis. And, ortho wanted them for a possible septic. You think to yourself, “what am I or my consultant going to do with these test results?” “What are these inflammatory markers anyhow?” And, “what patient’s should I be ordering them in.”
Read MoreDr. Axelson kicked off Grand Rounds this week with a look at DKA, hypercalcemia, suicide in the ED and more during M&M. Then we learned about Hereditary Angioedema, Thyroid Emergencies, Concussions, NIPPV and got a chalk talk about setting end goals of resuscitation from Dr. Dave Norton.
Read MoreAutumn is here -- the air is getting crisper, the days are getting shorter, and there’s no better time to get outside. It will likely come as no surprise that a sedentary lifestyle negatively impacts mood.
Read MoreThis week we learned about all the hardware that can go into our patient's CNS and how it can go wrong. We also heard about complications of Varicella infection, set out to optimize visualization of a needle on US, learned to give better feedback to the difficult learner, heard about ED super-utilizers and strategized about ventilator management.
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.
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