We 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 MoreVenous thromboembolisms (VTE) are difficult enough to diagnose and treat in the standard patient. However, this becomes even more of a challenge in the pregnant patient. In this post, we will discuss in depth the work up of VTE in the pregnant patient, which often requires slightly different risk stratification tools. We will also discuss various treatment options for VTE in pregnancy and the post partum period.
Read MoreIt was a stellar week here at UCEM Grand Rounds! We kicked off the day with a lecture from our colleague at CCHMC, Dr. Dean, about management of pediatric airways. We then transitioned to a review of landmark studies in EM, specifically with regards to targeted and systemic thrombolysis for MI, stroke, and PE. We continued our day by discussing evidence based medicine and the implementation of this in the prehospital setting with EMS faculty, Dr. Richards. Next, Drs. de Castro and Thompson faced off in an epic battle of CPC where we covered the diagnosis and management of euglycemic DKA. This was then followed by Dr. Vaughan’s R1 diagnostics and therapeutics lecture on pneumothoracies. Finally, we wrapped up the day with Dr. Gillespie’s R4 capstone lecture.
Read MoreThis week’s Grand Rounds started with 2 hours of M&M tips with Dr. Broadstock, Small groups followed with Thoracentesis with Dr. Milligan, Lung Ultrasound with Dr. yates and Trach Management with Dr. Gillespie. Functional Movement Disorders with Dr. Eltatawy rounded out a great Grand Rounds!
Read MoreNothing is scarier than the patient that you suspect is going to decompensate in front of you, and nothing will make that case more than seeing a clot in transit on bedside echo. Join Dr. Wolochatiuk as she discusses the signs of right heart strain and management of a patient with clot in transit.
Read MoreDuring this week’s Grand Rounds, Dr. Frederick presented Morbidity and Mortality and the ultrasound team taught us how to perform femoral nerve blocks. On themselves.
Read MoreIn this week’s Grand Rounds, Dr. Skinner introduces updates to EMS protocols , Dr. Gressick discusses thrombotic complications in COVID-19, Dr. Hunt shares her tips to avoid burnout in residency, Dr. Sobocinski walks us through nephritic and nephrotic syndromes, Dr. Yates challenges Dr. Hughes to diagnose an infected urachal remnant, and Drs. Broadstock, Comiskey, Kimmel, and Winslow discuss the diagnosis and treatment of uniquely Floridian dangers.
Read MoreDuring this week’s Grand Rounds, Dr. Urbanowicz presented Morbidity and Mortality, Dr. Ijaz discussed the diagnosis and management of aortic dissection, Dr. Walsh shares tips for thoracentesis and dosing for systemic tPA, and Dr. Oteng joins us to share his experiences in global emergency medicine.
Read MoreIt is the last Grand Rounds of the academic year and we have some heavy hitters this week! Dr. Hughes reviews cases and shares clinical pearls in this month’s morbidity and Morbidity and Mortality. Dr. Wolochatiuk tames a crashing pulmonary embolism in the SRU. Dr. Skrobut discusses the toll that EM takes on all of us. Dr. Paulsen discussess supervision, professional development, and burnout.
Read MoreClosed out 2020 UCEM Grand Rounds with a bang! Dr. Mand presented an abundance of evidence in this month’s Morbidity and Mortality conference. Guest lecturer Dr. Collins presented an approach to fever in the traveler for Global Health Grand Rounds. Drs. Gottula, Skrobut, Makinen, & Hinckley made us vent experts with Air Care Grand Rounds.
Read MoreJoin us as we explore our EMS Grand Rounds with Dr. Gray, discussion of pain management in pediatrics with Dr. Bryant, and the evidence-based approach to pericarditis treatment with Drs. Stevens and Jensen. Drs. Chuko and LaFollette then go head-to-head in our beloved CPC, Dr. Martella takes us through the diagnosis and management of myasthenia gravis, and Dr. Berger outlines the importance of taking care of our critically ill patients with humanity and kindness in his R3 Taming the SRU lecture. Lastly, Dr. Gottula wraps up with a discussion on how to excel at the little things during his R4 Capstone.
Read MoreThis week’s Grand Rounds started off with Dr. Minges walking us through how to perform ultrasound-guided regional anesthesia. Drs. Curry and Ryan then presented the first Year Directives of the academic year discussing EMTALA criteria and how to negotiate a contract. Drs. Wosiski and Iparraguirre expertly discussed the literature behind angioedema management. Drs. Crawford and Doerning battled it out on a case involving hiccups (read to find out more about this fascinating case). And lastly, Dr. Stratton from our PEM division walked us through how to approach the pediatric patient and pearls on how to determine “sick” from “not sick".”
Read MoreWe had another exemplary installment of Grand Rounds this week that started with Attending Case Followup with Drs. Lang, Baez, and Paulsen. Then we had some top-notch review of core curriculum with Dr. Winslow and the Alvarado Score for appendicitis, Drs. Meigh and Klaszky on food impactions and esophageal foreign bodies, and Drs. Comiskey and Nagle on D-dimer. Finally, Dr. Nagle gave us an overview of the foundations of evidence-based medicine with his R4 capstone.
Read MoreIn times of COVID, a Dimer of 3000 is nothing to look twice about, however there was an earlier (and future) time where the D Dimer is the hallmark of pulmonary embolism risk stratification. Dr. Comiskey breaks how how this once dichotomous tool has recent data to increase its specificity in elderly patients, pregnant patients and those with low pretest risk factors. Take a look, and when this whole pandemic is over your quiver will be fuller of Dimer tips.
Read MoreDr. Golden kicked grand rounds off this week with our monthly morbidity and mortality conference, followed by Dr. Lane’s deep dive on massive pulmonary embolism in cardiac arrest and how to approach this. Dr. Owens then gave us a detailed review on a probably-more-common-than-you-think parasite that has started popping up in the US, and our excellent ED pharmacists gave us a crash course on common antidotes to various poisonings, overdoses, and bites that we frequently see in the ED. Finally, Dr. Ham finished up with a review of the importance of chronic hypertension in our ED population and how we can make a difference especially those with limited access to care.
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.
