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Grand Rounds Recap 1.15.20
We had another great week in Grand Rounds, starting with a QI/KT presentation from Drs. Hunt and Pulvino about Tumor Lysis Syndrome. Next, Dr. Meigh gave a great presentation about TORCH infections and Dr. Spigner gave his R4 Capstone lecture on pre-hospital sepsis care. We welcomed a guest speaker, Dr. Henning, from podiatry who discussed a number podiatry emergencies. Finally, the week wrapped up with a simulation of an inferior STEMI in trauma.
Prehospital Stroke Triage
Over the past 5 years, there has been a dramatic expansion of the treatment strategies used to treat patients with acute ischemic stoke. As some of these treatments involve specific resources only available at certain institutions, appropriate triage of patients in the prehospital environment is becoming ever important. On one hand a patient who would best benefit from endovascular treatment triaged to a center without that capability will undoubtedly suffer a delay in care. On the other hand, over-triaging stroke patients to a comprehensive stroke center could overwhelm the resources of that center, potentially impacting the care of patients at that center. In the podcast below, we talk with Dr. Jason McMullan of the UC EM Division of EMS and Dr. James Li, PGY-3 who both have recent publications focusing on this phase of patient care.
Is a Bag Enough?
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?