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Grand Rounds Recap 1.29.20
This week we had another great M&M where Dr. Klaszky covered exciting topics such as refractory V fib, hypothermia and cerebral malaria. We learned about misnomers, mimics and lies about TB from Dr. Owens. Dr. Zalesky skillfully walked us through a simplified approach to reading brain MRIs. Lastly, Dr. Leech and Dr. Goel faced off in a CPC involving a patient with ALS.
Hypocalcemia in Trauma
We are all familiar with the “lethal triad” of trauma – coagulopathy, hypothermia, and acidosis. We have multiple methods wherein we attempt to prevent or reverse these physiologic derangements. In particular, in recent years many teams have focused heavily on limited crystalloid infusions, increasing our early blood product transfusion (especially plasma), and early administration of tranexamic acid.
One of the main reasons we focus on these interventions is to address trauma-induced coagulopathy. Trauma-induced coagulopathy has a multifactorial etiology and is contributed to by the other corners of the triad (hypothermia and acidosis). However, one of the least appreciated contributing factors are electrolyte deficiencies, in particular calcium.
Diagnostics: Brain MRI
If you have ever nodded along as someone described an MRI series weighting, you are not alone. As this modality becomes more accessible to the Emergency Physician, it is incumbent on us to familiarize ourselves with the critical aspects and critical diagnoses of MRI and how to speak the language. Dr. Zalesky takes us on a tour of the physics, indications and low-down of MRI from the ED.