Air Care Series: No Lung No Problem - VV ECMO
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No Lung? No problem! Join Liz Powell, Paige Barger and Adam Gottula as they take a look at the basics of VV ECMO in the transport environment.
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X-ray Vision - Shoulders and Elbows
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Upper extremity trauma and pain related complaints are frequently encountered in the Emergency Department. In this post, we cover the basics of the anatomy of the shoulder and elbow joint, the radiographic studies frequently performed in the evaluation of shoulder/elbow injuries, and cover some commonly encountered injuries of these joints.
Read MoreGrand Rounds Recap 10.9.19
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This week we continued our leadership curriculum with Dr. Pancioli’s lecture on the intersection of leadership and finance. This was followed by Dr. Klaszky with his R4 case follow up of a patient with cardiac tamponade, and then Drs. Baez and Continenza faced off for the most recent installment of our Great Debate series as they discussed chemical vs electrical cardioversion for atrial fibrillation. Finally, our colleagues from Cincinnati Children’s presented learning pearls about causes of and interventions for hypoxia in pediatrics emergency medicine.
Read MoreGrand Rounds Recap 10.02.19
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In this week’s Grand Rounds we discussed spinal fractures and imaging of knees and hips with our R1s, Drs. Kimmel and Gressick. Dr. Hassani from the R2 class took on Dr. LaFollette with a case of thyrotoxicosis presenting as a-fib with RVR in his CPC, and Dr. Koehler from the R3 Class taught us about heroin/naloxone-induced pulmonary edema. Dr. Golden from the R4 class discussed Fournier’s Gangrene complicated by sepsis-induced cardiomyopathy, and finally our trauma surgery colleague Dr. Pritts discussed some hot topics in trauma.
Read MoreSepsis Journal Club Roundup
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The management of patients with sepsis can be exceptionally complex. As with many patient’s with complex critical illnesses, often times attention to seemingly minor aspects of the patient’s management can have significant impacts on the patient’s course of illness. In this recap of our most recent journal club, we review 3 such aspects of the care of patients with sepsis. Does the type of IV fluids really make a difference? Are steroids a friend or foe in the care of these patients? And can the simple bedside assessment of capillary refill replace serial measurements of lactate?
Read MoreUltrasound of the Month: Lower Uterine Segment Gestation
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Characterizing location of an intrauterine pregnancy is a key portion of the sonographic exam in early gestation. In this month’s case Dr. Leech describes a case concerning for lower uterine gestation, as well as the diagnostic and therapeutic considerations for this pathology.
Read MoreDiagnostics: Knee and Ankle X-rays
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Hip and knee pain almost categorically get an X-Ray in the ED, but when do you need more? And when could another view help you avoid a more costly imaging test? This week join Dr. Gressick as she gets back to the basics in the acquisition and interpretation of the hip and knee X-Rays
Read MoreGrand Rounds Recap 9.25.19
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This week Dr. Klaszky started us off with a great M&M of reviewing tPA and sumitriptan indications, EMTALA background and more. Dr. Chuko led a small group discussion of syncope rules based on his post from earlier in the week, Dr. Roblee tried to stump a faculty during her CPC of a syphilis case. Check it all out in this week’s GR Recap!
Read MoreMastering Minor Care: Ankle Arthrocentesis
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Far too often we are faced with the situation in which we are concerned about septic arthritis in a patient’s ankle. Although tapping the ankle can be a daunting task, Dr. Leech provides us with a guide in this month’s minor care post to make difficulty with ankle arthrocentesis a problem of the past.
Read MoreFalling Out - Syncope Evaluation in the Emergency Department
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Syncope is a common presenting complaint to the emergency department. Estimates suggest that 1- 3 percent of ED visits are for syncope.(1) While the large majority of these episodes are often benign, they can suggest underlying life-threatening etiologies such as arrhythmias, pulmonary embolism, and stroke. The disposition of these patients can represent a difficult quandary at times. In fact, emergency physicians are only able to establish a clear underlying diagnosis in approximately 50% of syncope patients after obtaining an HPI, physical exam and ECG. (2)
Should these patients be observed in the ED? And, if so, for how long? Should they be admitted to the hospital for further workup and observation? Should they instead be discharged home with close follow-up?
Read MoreGrand Rounds Recap 9.18.19
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This was a great week of Grand Rounds with a number of interdisciplinary presentations. The week started off with Dr. Neel presenting about common neurologic complaints in the ED in our first EM-Neurology combined lecture for the year. Dr. Jarrell then presented her R4 Case Follow Up lecture on a case of blunt pancreatic injury in non-accidental trauma. Dr. Wyrick, from the Department of Orthopedics, talked about his experiences on his global health trip to Tanzania. Finally, the week wrapped up with Drs. Iparraguirre, Jensen, and Lane leading small group workshops on orthopedic injuries.
Read MoreIs a Bag Enough?
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Trauma scene flights are often the first thing people think of when they think of Helicopter EMS. Although we know that HEMS and Critical Care Transport involves much more than just scene flights, they are still a critical part of most HEMS programs’ mission and capabilities. In addition, many flights are “modified scenes” or “scene intercepts,” meaning the HEMS crew meets the EMS crew at an outlying hospital helipad, or arrives shortly after the patient’s arrival to an under-resourced ED. Many of these patients are critically ill, and a subset will require intubation and ventilation. Once intubated is bag valve ventilation enough? Or should all these patient’s be placed on a mechanical ventilator?
Read MoreAir Care Series: Machines Inside of Machines - CPR in flight
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While high-quality CPR delivers the best outcomes in cardiac arrest, this is challenging in a transport environment. Dr. Connelly reviews the evidence behind mechanical chest compression in CPR, exploring its practicality to the Helicopter EMS (HEMS) environment.
Read MoreGrand Rounds Recap 9.11.19
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Drs. Winslow and Habib started the Grand Rounds off with a case-based discussion on the Centor Criteria and testing for strep pharyngitis. Drs. Walsh and Sabedra led an interesting discussion about a case of TTP. In his R4 Case Follow Up lecture, Dr. Nagle presented about DKA and family presence during resuscitation. Dr. Hogan, one of the EMS Fellows, gave a great presentation about the current controversies in cardiac arrest management. Finally, the week wrapped up with some great simulation and cases from our PEM fellows about post T&A bleeds, PTA, and acute chest syndrome.
Read MoreA Helping Hand
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Medication Assisted Therapy or MAT is a critical component of the care and treatment of patients with opiate use disorder. Over the course of the past several years, more and more ED providers, have been on the front line of initiating treatment of patients withdrawal symptoms and linking those patients to outpatient resources. In this post, we review the initiation of Buprenorphine based treatment for opiate use disorder in the ED.
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