Clinical Diagnostics: Laboratory Studies in Hepatic Failure

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Clinical Diagnostics: Laboratory Studies in Hepatic Failure

There are many groups of patients that alter how we must evaluate and interpret our diagnostic studies in the setting of baseline chronic laboratory abnormalities, which is often challenging. One especially challenging patient population are patients with chronic liver disease, and in this post Dr. Jarrell will take us into how their disease process creates chronic and acute on chronic derangements of which we need to be aware in daily and emergent management of these patients. 

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Annals of B-Pod: Quick Hit Case

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Annals of B-Pod: Quick Hit Case

The second installment from the December Issue of Annals of B Pod, Dr. Ham presents a female patient with no past medical history who presents to the Emergency Department shortly after stepping through a picture frame that was propped up on her floor at home. The glass shattered, lacerating the posterior aspect of her left lower leg. She is complaining of difficulty walking, but denies loss of sensation distal to the injury...

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Grand Rounds Recap 11.30.16

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Grand Rounds Recap 11.30.16

This week in UCEM Grand Rounds: the harrowing story of the desaturating trauma patient with a metal pole impaled through his mouth and neck. Also: making the diagnosis of HIV in the ED. Managing hemorrhagic shock on Air Care. How much did that ED visit or hospitalization cost your patient? Managing tachy-arrhythmias in the setting of cardiac arrest with a pacemaker.

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Annals of B Pod - B Pod Case: Taking Renal Failure to Heart

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Annals of B Pod - B Pod Case: Taking Renal Failure to Heart

The first article from the December 2016 issue of Annals of B Pod is of a patient that is a male in his late 30s with a past medical history significant for trisomy 21, stage III chronic kidney disease of unspecified etiology, and hypertension who presents to the Emergency Department with emesis and dark stools.  The patient is unable to contribute significantly to his history, but his family relates that two days prior to presentation, the patient experienced two episodes of “coffee ground” emesis according to the patient’s home health nurse. Over the next day, the patient subsequently experienced several episodes of melenic stools. His family also notes that he has seemed feverish, more lethargic, and less active than his baseline.

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Grand Rounds Recap 11.16.16

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Grand Rounds Recap 11.16.16

This week, Dr. Grosso led us through some fascinating case review during M&M. We had a fantastic, practical review of minor-care related hand complaints led by our R3s Drs. Teuber, Gorder and Plash. We learned about injury management in resource-limited settings during Global Health Grand Rounds with Drs. Roche, Lagasse, Teuber. Dr. Soria and Dr. Riddle gave us their R2 and R4 case follow-ups, respectively.

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Grand Rounds Recap 11.9.16

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Grand Rounds Recap 11.9.16

This week we got put in the hot seat with oral boards on AAA rupture, SVT and eclampsia, a simulation with end-of-life discussions, a critical beta blocker overdose from Dr. Lagasse and some Peds EM tips on conscious sedation from Cincinnati Children's PEM Fellow Dr. Lee. Click to check out more highlights from this week's Grand Rounds!

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Grand Rounds Recap 11.2.16

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Grand Rounds Recap 11.2.16

This week we were honored to have Dr. Michael Weinstock visit from The Ohio State University to discuss legally defensible documentation. Dr. Sabedra challenged Dr. Toth with her CPC. Dr. Habib gave us a review of viral hepatitis serologies, and Dr. Powell offered us her case follow-up masters class!

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Hepatitis Panel Interpretation

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Viral 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.

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Grand Rounds Recap 10.26

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Grand Rounds Recap 10.26

We 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.

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Crash and Burn Part 2 - Approach to the MVC Patient

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Crash and Burn Part 2 - Approach to the MVC Patient

We’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?

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