Grand Rounds Recap 2/13/19

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Grand Rounds Recap 2/13/19

This week, we started Grand Rounds with ED-critical care research brought to us by UC Alumnus Dr. Brian Fuller. He discusses ventilator management in the ED and how ED sedation may affect patient outcomes. Dr. Harrison then presented an overview and common utilization errors of ED observation from his year as a Resident Assistant Medical Director, followed by Dr. McKee’s case of inhalational chlorine exposure. Dr. Alwan discussed updates to the less than 60 day fever protocol at CCHMC and Dr. Zozula walked through the dispatcher assistance protocols to give us an idea of what happens before they enter the ED doors.

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Grand Rounds Recap 2/6/19

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Grand Rounds Recap 2/6/19

It was an exciting week of Grand Rounds! We had the honor of hearing from legendary UCEM graduate Dr. Susan Stern who was the Dr. Gibler Visiting Professor. She discussed hemorrhage in trauma and the changing landscape of leadership in medicine. This was followed by operations updates with Dr. Palmer, and Dr. Laurence discussed AIDS-defining illnesses in her clinical knowledge lecture. The day concluded with a review of some Air Care cases. Check it out!

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Grand Rounds Recap 1.30.19

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Grand Rounds Recap 1.30.19

Welcome to another grand rounds recap! This week Dr. Isaac Shaw started us out with the monthly Morbidity and Mortality. Dr. Stolz then dove into some ultrasound QA, covering topics such as knee arthrocentesis and early pregnancy ultrasound. Dr. Murphy followed this up by discussing the science of motivation and how we can use this in the Emergency Department setting. This was followed up with Drs. Modi and Kircher who went head to head in this months CPC on endocarditis. Dr. Irankunda finished up the day with an excellent talk on the retrograde urethrogram. See you next week!

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The Importance of the RUG

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The Importance of the RUG

It is early on in your residency training, when you receive sign-out of a patient who was involved in an MVC with multiple injuries including a stable pelvic injury. The patient, a middle-aged male, has not voided three hours into his visit and there is no mention of any obvious genital trauma.  He has had a negative FAST exam in addition to the rest of your primary and secondary assessment. The patient mentions to the nurse that he is trying to urinate but cannot void and has some discomfort. The bladder scan shows that the patient has about 500cc of urine and when the nurse goes to place a urinary catheter she pauses as she sees what appears to be dried blood at the urethral opening. After reassessing the patient who is still hemodynamically stable with normal mentation, his findings are discussed with Urology who recommend getting a retrograde urethrogram prior to any additional procedures. 

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Grand Rounds Recap 1.16.19

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Grand Rounds Recap 1.16.19

Welcome to another Grand Rounds Recap. This week Dr. Sayal, a visiting lecturer from North York General Hospital in Toronto, Canada, started us off with some pearls and pitfalls for the patient presenting with musculoskeletal complaints. Next up was Dr. Thompson who provided us some tips on how to prevent the most common patient and consultant complaints in the emergency department. Dr. Habib then led us through an interesting case involving an internal degloving injury. We then ended the day with small groups and a simulation led by Drs. Baez, Shaw, and Summers involving emergency obstetrical presentations. Be sure to check out the video of Dr. Isaac Shaw’s peri-mortem c-section simulation. See you next week.

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The Head and the Heart: Hemodynamic Derangement in Isolated TBI

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The Head and the Heart: Hemodynamic Derangement in Isolated TBI

We know that alterations in hemodynamics do not only occur in hemorrhagic shock.  Both obstructive (such as from tension pneumothorax) and neurogenic shock (for example, from a spinal cord transection), can result in hemodynamic compromise that would not be corrected by blood product administration.  There have been some studies that have shown isolated traumatic brain injury (TBI) can also cause hemodynamic derangements. This article looks at a paper which attempts to examine the incidence of cardiovascular instability in patients with TBI.

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Grand Rounds Recap 1.9.19

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Grand Rounds Recap 1.9.19

We are excited to share our latest installment of the Grand Rounds Recap with you! Dr. Stettler opened the day with a discussion on leadership styles and how they affect our practice in the emergency department. Next up was Dr. Sabedra with a riveting case of new onset heart failure and acute ischemic stroke in a patient in his twenties. Dr. Berger then gave us a shot to the gut, in a good way, with a lecture on colitis. We then delved into the world of pediatrics with a lecture by Dr. Gray who helps us standardize our approach to evaluating for the possibility of child abuse. Dr. Hughes and Dr. Gottula then ended the day with a practice changing summary of the current literature and a new pathway for the management of NSTEMI.

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Annals of B-Pod: Human Trafficking

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Annals of B-Pod: Human Trafficking

Though we may not realize it, human trafficking continues to consume the lives of young women and men throughout the world, including the United States. In this excellent piece, Dr. Jarrell details a presentation of a victim of trafficking to the emergency department and discusses various historical and physical exam findings that should raise a provider’s concern for possible human trafficking.

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Grand Rounds Recap 1.2.19

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Grand Rounds Recap 1.2.19

We had an excellent series of lectures this week at our Grand Rounds to welcome in the New Year! The esteemed Drs. Calhoun and Stettler started us off with our Great Debate series pitting Ketofol against Ketamine or Propofol alone for procedural sedation. The winner of this debate? Definitely the audience who got to soak up the expertise from these clinical giants. Next up was Dr. Leenellett who guided us through some community ED cases of early pregnancy vaginal bleeding in our Discharge, Transfer, or Treat lecture series. Dr. Laurence then led us through a small group case based discussion on the indications for massive transfusions in trauma. Then a hush fell over the crowd as Dr. Iparraguierre laid down the CPC gauntlet with a presentation of Myasthenia Gravis for Dr. LaFollete who masterfully identified the Ice Pack Test as the diagnostic test of choice! Next up was Dr. Colmer who gave some tips for the management of severe alcohol withdrawal with his case follow-up lecture. There was no knocking this knowledge train off the tracks as Dr. Urbanowicz led us through a harrowing discussion on Weapons of Mass Destruction. To round out the day Drs. Klaszky, Gauger, and Murphy Crews led us through some small group exercises on the NIH stroke scale, CT angiography of the head and neck interpretation, neurological emergencies jeopardy, and indications for performing a burr hole with some hands on practice (simulation of course!).

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Massive Transfusion Triggers: Back to the ABCs (score)

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Massive Transfusion Triggers: Back to the ABCs (score)

Massive Transfusion (MT) is a life-saving trigger in trauma centers, but heavy is the burden of activating significant resources without knowing the blood products will go to good use. The ABC is the ACS recommendation, is easy and requires no additional testing, however newer weighted scores like PWH and TASH have showed promise in external validations. This week, Dr. Laurence takes a deep dive into the literature behind these triggers, their validation as well as some take aways for your use of life-saving Massive Transfusion.

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Grand Rounds Recap 12.19.18

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Grand Rounds Recap 12.19.18

Come check-out our Grand Rounds Summary for 12.19.18! We started the morning with some fascinating cases in Morbidity and Mortality Conference with Dr. Baez. Next, we learned the importance and efficacy of mindfulness with Dr. Bernardoni. Dr. Makinen and Dr. Curry went head-to-head on a Clinical Pathologic Conference about a patient with hyperthermia due to sympathomimetic overdose. Lastly, Dr. Frederick taught us the evidence behind PECARN!

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To Scan or Not to Scan? PECARN for Pediatric Head Trauma.

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To Scan or Not to Scan? PECARN for Pediatric Head Trauma.

When a child comes in to the emergency department for head trauma, it can be difficult to balance unwanted, and possibly unnecessary radiation, with the risk of missing clinically significant head trauma. CT scans of the head allow providers to rapidly identify, and subsequently address dangerous and potentially life-threatening intracranial trauma and hemorrhages. However, as with everything in medicine, a CT scan is not without risks, particularly in the pediatric patient. With over 500,000 ED visits per year dedicated to pediatric head traumas, this is a challenge that emergency medicine providers face frequently (1).  A study published in 2001 suggests that approximately 170 deaths were attributable to one year of CT head examinations in pediatric patients (2), and utilization of CT imaging has only increased since. Therefore, as with any radiation based imaging, careful consideration should be given to whether the test is truly necessary. As mechanism of injury and post-trauma symptoms can range drastically, it can be difficult to accurately assess the appropriateness of imaging in a child. As such, the pediatric emergency care applied research network (PECARN) worked to develop a clinical decision tool to guide clinicians in the need for head CT following pediatric head trauma.

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