In this AirCare case, Dr. Murphy eloquently details his experience in managing something every emergency physician fears - the need for a crash airway in a patient with severe airway injuries. Dr. Murphy discusses both the technical evaluation of a patient for a potential cricothyrotomy as well as his personal thoughts and reflections following the procedure.
Read MoreWhile compartment syndrome of the extremities is a much feared complication - what happens when you get compartment syndrome of the abdomen? Does this mean you really shouldn't trust your gut? In this article, Dr. Harty discusses through the evaluation and management of abdominal compartment syndrome in this week's issue of Annals of B-Pod.
Read MoreAs emergency medicine physicians, we are expected to put our best foot forward in the thorough evaluation of lower extremity injuries. In this Quick Hit, Dr. Banning walks us through the identification and management of a relatively rare but important podiatric injury.
Read MoreThe topics covered in this Spring’s installment of Annals of B Pod highlight the variety of medical knowledge and procedural skills used daily in the Emergency Department. In B Pod, there may be a patient with an intentional ingestion brought in by EMS next door to a patient with a cough who is discovered to have pneumonia, while on the other side of the pod there is a patient complaining of eye pain. All of these patients represent common chief complaints with broad differentials that interns learn how to work up, manage, and treat. Spring also marks a transitional time, when interns start stepping up to into the junior resident role. With this transition, interns broaden their procedural skill set by learning how to place central lines, perform intubations, and insert chest tubes. As the year progresses, interns see more pathology, learn about new disease processes, and acquire procedural skills.
Read MoreKnow your CAP from your HAP from your HCAP? The language of pneumonia is changing and Dr. Owens takes us through a B Pod case to demonstrate some nuances to the 2016 ISDA/ATS guidelines that will change the way we define, and treat, pneumonia.
Read MoreA female in her 20s comes in with reported overdose 4 hours prior to arrival. Anxious appearing she seizes on arrival to the pod. What's your differential and once diagnosed how do you do to manage this critically ill serotonin syndrome?
Read MoreIn this Winter 2016 edition of Annals of B Pod, we focus on cardiovascular emergencies and their management in the Emergency Department and beyond. In our new Air Care column, we write about the prehospital management of patients with profound cardiogenic shock requiring intra-aortic balloon pumps. In our recurring pharmacology column, we discuss the ED management of hypertensive emergency. Back in B Pod, Dr. Scanlon writes about a rare complication of renal failure in a patient with a large uremic pericardial effusion, and in our new procedure piece, we walk through the technical steps required to perform an emergent pericardiocentesis. On the back page, our EKG corner goes over the modified Sgarbossa criteria. This issue of Annals of B Pod gets back to the heart of it all, highlighting what makes residency so rewarding: interesting pathology, challenging procedures and clinical excellence.
Read MorePatients typically present to the Emergency Department with one complaint. The chart says “Headache” or “Abdominal Pain” but B-pod implores us to look closer. B-pod teaches us that it is our job to sit down, take a few extra minutes, and look at the entire patient in front of us...
Read MoreIn July, the entire emergency department is full of firsts; firsts shift in a new pod, first solo flights, first successful codes, and first shifts supervising new providers. This is an exciting time -- full of new faces and new roles. July can also be scary. All of those new roles come with uncertainty, fear of the unfamiliar, and immense responsibility.
This issue features cases and #lessonslearned from graduates whose “firsts” were not so long ago. These are showcased to serve as a reminder to us all that although this month is full of firsts for the residents, our faculty, nurses, and department have seen many Julys pass and are ready and eager to teach us their own #lessonslearned. Check out the new issue to see!
This season's issue of Annals of B Pod we highlight clinical cases from our ED's B Pod to feature some complex cases starting with simple chief complaints, emphasizing the point that the sickest patients evolve from the mundane. Flu season continues to plague us and every day we face the question of how far to take the clinical evaluation when we see generic complaints. The decision comes partly from objective data, partly clinical decision rules, and mostly from a non-quantifiable summation that is clinical gestalt.
78 year old male with past medical history coronary artery disease status post stenting, hypertension, hyperlipidemia, chronic kidney disease presents with a chief complaint of double vision, feeling off balance. Patient states he awoke this morning with double vision. He states this sensation of double vision is worse when he looks side to side, and completely resolves when he closes one of his eyes. He does not wear glasses or contacts and denies any eye pain or trauma. Also, since this morning he has felt somewhat off balance, however denies any focal numbness or weakness of extremities. He noted an episode of slurred speech approximately 1 hour prior to arrival that has since resolved. No other difficulties with word finding or language. Otherwise patient denies headache, head trauma, neck pain, chest pain, or shortness of breath. He has not had symptoms like this in the past.
Read MoreDifficulty Swallowing
The patient is a 22 year old female with no significant past medical history who presents to the ED with a chief complaint of dysphagia. The patient first noticed difficulty swallowing solid foods 2 weeks ago. She states that she felt like food was getting caught in her throat. Initially she only had difficulty swallowing solid foods and was able to eat soft foods and liquids. However, she reports that over the course of two weeks her condition gradually worsened to the point where she could no longer tolerate fluids. She states that she has pain in the back of her throat when she attempts to swallow.
Read MoreA 34 year old male presents to the ED complaining of swelling and pain after eating... What's your diagnosis and management?
Read MoreIf you are interested in seeing the placement of a Transvenous Pacemaker after reading this post check out Part 2 (Procedural Slide Set) and Part 3 (the first person view of the procedure)
Reasons to Pace in the First Place
Hemodynamically unstable+
1. Sinus Bradycardia - seen in 17% of acute MI patients (especially inferior or anterior wall MI) [1,2]
2. AV Block - may be due to ischemia (15-19% of all Acute MI) [2,3]
3. Drug Overdose - with the goal of maintaining adequate hemodynamics while your medical therapy/dialysis has an opportunity to work.
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.
