In March 2015, Dr. Renne did a Grand Rounds lecture on soft tissue neck radiographs, which offers a great review of normal anatomy and systematic approach to reading films (“CHESS”). Yet, in my small, informal (not scientific at all) poll of some of our residents, none had ever ordered a soft tissue neck film. Are soft tissue neck radiographs useful? You be the judge.
Read MoreIf the chief complaint of your patient is abdominal pain, altered mental status, overdose, generalized weakness chances are you at least considered ordering a hepatic panel. In fact, studies show that the hepatic panel is the third most common laboratory test ordered in the emergency department only behind the CBC and renal panel. If emergency medicine physicians are so quick to order this test, it is important to also know how to interpret all the little red arrows that often accompany your results. For this we will review each component and even (wait for it) … a little biochemistry!
Read MoreAmongst the various diagnostic studies that can be obtained in the ED, urinalysis is a virtually ubiquitous test. Urine itself reflects the functioning of the human body in both health and disease and the values it comprises can give us information regarding a myriad of conditions from infections, metabolic or endocrine derangements, and toxidromes to neoplastic processes and pregnancy. Despite this, many of the elements of even the standard urinalysis are often overlooked and underappreciated. In this talk we will explore some of these values and hopefully gain a renewed respect for the “golden cup of answers” and all that it may reveal.
Read MoreThis week in Grand Rounds: A case of Thyrotoxic Periodic Paralysis, Cardiac Biomarkers, Takotsubo Cardiomyopathy in a head bleed, and pearls of airway management during Air Care Grand Rounds including needle cricothyroidotomy.
Read MoreEver have a patient present with foot or ankle pain? In case you have, here is a refresher on the radiographic anatomy of the foot as well as the test characteristics and viability of the use of the Ottawa Rules in the ED setting by Dr. Golden.
Read MoreThis week we learned about risk stratification for PE and how to work it up in special populations. We covered neonatal resuscitation and pediatric hematologic emergencies. We got a crash course in the returning traveler with fever. We reviewed current guidelines for treatment of sexually transmitted infections.
Read More“Reason itself is fallible, and this fallibility must find a place in our logic.” - Nicola Abbagnano
Decision making in Emergency Medicine is intensely complex and it also the defining characteristic of the practice of Emergency Medicine. To outside eyes we may seem to be a specialty of action: chest tubes, intubations, heroic resuscitations with massive amounts of blood products and IV infusions. In truth none of the “action” of our specialty, the big sexy things they make into TV shows and movies, occurs without rapid, precise, and accurate thinking and decision making. But the Emergency Department can be a hostile environment to the decision making process. And, I’m not just talking about the noisy environment, the multiple interruptions, the patients with a wide variety of chief complaints and acuity seen in quick succession. There’s seemingly a thousand different hurdles between the instant a patient recognizes that something might be wrong with them and the moment a clinician diagnoses the problem.
Read MoreThromboelastography (TEG) measures the dynamics of clot development, stabilization/strength, and dissolution. Assuming the body’s ability to achieve hemostasis is a function of these clot properties, TEG provides specific, real-time indicators of a patient’s in vitro hemostatic state. This is in contrast to routine screening coagulation tests such as aPTT and PT/INR which are run with blood plasma alone and therefore do not take into account the cellular components of clotting.
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.
