We had an exciting Grand Rounds this week. We started off with our visiting lecturer, Dr. Jennifer Wiler, who gave us an excellent overview of the dollars and cents behind the care that we provide in the emergency department. Afterwards we practice some oral board style cases. Dr. Betz led a challenging triple patient encounter where we had to simultaneously manage a knee dislocation, aortic dissection with involvement of the right coronary artery, and pneumonia in the setting of HIV. Dr. Curry led a riveting case of preeclampsia where identifying the critical history of a recent delivery was critical to initiating the correct management. We wrapped up the day with a simulation led by Drs. Hill, LaFollette, and Lang on in-flight emergencies!