Many clinical decision rules exclude elderly patients from the derivation cohorts. So the question remains unanswered do all elderly patients need cervical spine CTs in the setting of trauma? What if they have no symptoms? This recap of a journal club article explores the incidence of significant cervical spine fractures in elderly patients.
Read MoreIt is well known that ultrasound has exploded in its application in both diagnostics and procedures and has ultimately revolutionized the way we practice medicine. With its growing use, more and more providers are comfortable using ultrasound for both identification of anatomy/pathology and to guide procedures that were previously only done with landmarks. While having the skills to perform landmark guided procedures is incredibly important, there is much value in being able to visually confirm anatomy to avoid procedure complications, especially when landmarks are difficult to palpate / identify in certain individuals. This recap of a recent journal club article covers a paper looking into the use of POCUS to help perform cricothyrotomy.
Read MoreDr. Pawlik walks us in depth through the evaluation, diagnosis and management of traumatic injuries to the eye.
Read MoreWhen I began my clinical informatics elective I planned to spend my time taking online courses on how to improve my Epic efficiency. After a day or so of online sessions I realized that (a) I’m already an Epic master (sort of) and (b) I hoped there was more to “clinical informatics” than faster documentation. So let’s begin at the beginning: what is clinical informatics?
Read MoreMore than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In this breakdown of a Journal Club article, Dr de Castro will cover a recent paper comparing NIPPV to oxygen mask only during preoxygenation for intubation.
Read MoreJoin Dr Haupt as she discusses the adrenal glands, their role in hormone production and other functions throughout the body, and common problems that can occur when the adrenal glands are not working properly. Although most of these issues are non emergent problems, occasionally they will be seen in some sort of acute adrenal crisis in the emergency department and ER physicians should be well versed in their often subtle presentations!
Read MoreSevere trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxemia. Emerging studies in the intensive care unit (ICU) setting suggest that liberal supplemental oxygen therapy and hyperoxemia is associated with increased mortality. Limited evidence in the trauma population suggests similar outcomes.
Read MoreWe know that the d-dimer can be a helpful test for patients who have a low pre-test probability of pulmonary embolism. But can the test be pushed into use for higher risk patients? Will it still have useful negative predictive value or will we risk missing too many PEs?
Read MoreDr. Guay walks us through pathology unique to patients with a history of bariatric surgery. From surgical complications to vitamin deficiencies, there is a lot to consider in the care of this population.
Read MoreOften the ED is the source of routine care after incarceration, and that is often secondary to issues with medicaid lapsing during incarceration and dropping a key linkage to care. Join Dr. Kate Gallen as she examines why this can happen as the first step to improving the system is knowing where it fails.
Read MoreEsophageal food impaction (EFI) occurs at an estimated rate of 13 episodes per 100,000 people annually. Medical management is typically attempted before resorting to endoscopy to reduce procedural risks and resource use. Glucagon remains the most widely used medication. Other treatments include carbonated beverages, benzodiazepines, and, more recently, nitroglycerin. Despite glucagon being the most commonly used agent, its supporting data are limited to small studies or case reports. One older study showing over 60% efficacy lacked a comparator group and had multiple confounders. Another study suggested only minimal benefit and significant adverse effects—up to 50% vomiting—highlighting the need for better treatment options.
Read MoreDr Boggust walks us through the most important considerations for patients who present to the Emergency Department with inhalation injuries from smoke and other noxious chemicals.
Read MoreTumor lysis syndrome (TLS) is rare disease presentation in the emergency department that is very important to learn to diagnose and treat due to the high associated mortality, often quoted at 20% or more. This post discussed the pathophysiology of the disease process, as well as how to appropriate identify and treat TLS in a timely manner to prevent complications such as cardiac dysrhythmias and acute renal failure.
Read MoreAnother week, another great Grand Rounds! First, Dr. Lang takes us through the evidence behind our common treatment of low back pain. Next, Drs. Boyer and Segev give us a evidence guided management of the acutely ischemic limb. Next, Dr. Hajdu takes us through a difficult case of cardiac arrest in the ED. Finally, we learn all about infections of the pelvis and perineum with Dr. Guay!
Read MoreNot all breathing is made equal, and a lot of it wheezes in the world of Emergency Medicine. Join Dr. Blaine Oldham as he reviews asthma and COPD and how to approach each with some nuance
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.
