Shan Modi, MD walks us through a critically ill patient with pulmonary embolism then breaks down the literature surrounding the management of Pulmonary Embolism both in the Emergency Department and Critical Care Transport Environment. We will cover fluid support, vasopressor usage, ventilatory management, vasodilators, ECMO and more!
Read MorePE is often a considered and easily risk-stratified diagnosis, however what about when you take away your definitive test of the CTPA? Dr. Ham examines the 60/60 sign and other ultrasonographic tests you can use to determine the acuity of right ventricular strain which is addition to the clinical and hemodynamic evaluation can help you triage additional strategies to traditional anticoagulation.
Read MoreThis week's Grand Rounds opened with year directives focused on residents as teachers for the junior residents and life as a junior faculty for the senior residents. Next Dr. Fermann discussed implementation of our PE response team (PERT). Dr. Li led a great group discussion on EKG toxicology, Dr. Golden then unsuccessfully tried to stump Dr. Hill with his CPC on phenytoin toxicity, and finally Dr. Gorder gave a fantastic discussion on NSTEMIs.
Read MoreThis week's Grand Rounds started off with our monthly Morbidity and Mortality conference with Dr. Titone. This was followed by a lecture on pediatric bloody diarrhea with Dr. Shan Modi. Dr. Claire O'Brien then gave her Clinical Soap Box lecture on cost and waste within the healthcare system. Dr. Kreitzer then gave an evidence based lecture on current research in sepsis and refractory septic shock, followed by our consultant of the month lecture with Dr. Anthony Blanchard from podiatry discussing foot wounds and osteomyelitis.
Read MoreThis week's Grand Rounds started out with another installment of our leadership curriculum led by Dr. Stettler, where we discussed how to identify and manage finance in leadership. This was then followed by Dr. Makinen's small group session on thyroid diagnostics in the ED. Drs. Gauger and Loftus then went head-to-head on a case of syncope, found to have a massive PE. Dr. Miller then gave a great summary of current thoughts and future approaches to sepsis, followed by Dr. Murphy discussing post-ENT procedure bleeds in the ED. Dr. Curry then finished off the conference with his "Mastering Minor Care" segment on epistaxis.
Read MoreThis week Dr. Lagasse gave us a great M&M covering intra-ocular foreign bodies, empyema management in the ED and septic cardiomyopathy. Dr. Iparraguirre lead small groups in EKG case studies in heart blocks, followed by Drs Nagle and LaFollette squaring off in a CPC of an undifferentiated patient with aphasia. Drs Goel and McKee wrapped up this week with a clinical soapbox on patient turnover and a case follow up of lytics in massive PE.
Read More'Twas a fantastic grand rounds. Drs. Banning and Golden started it off taking us through the most recent evidence for management of sub-massive and massive PE, as well as presenting their algorithm to be published on Emergency KT. This was followed by a global health lecture given by Dr. Lagasse, which covered a range of re-emerging infectious diseases. Next, Dr. Bryant took us through multiple pediatric cases, and discussed her approach in determining whether to discharge, transfer, or treat pediatric patients with common / representative complaints. Dr. Adeoye then took us through the history and development of our current approach to the management of acute ischemic stroke. Dr. LaFollette then took us through an evidence based approach to removing things from where they shouldn't be in his edition of mastering minor care, discussing approaches to removing retained objects from ears and skin. We then finished the conference with two interesting cases: One presented by Dr. Sabedra that was followed by a discussion on the diagnosis and management of massive hemoptysis, and the other presented by Dr. Dang illustrating the differences and similarities hyperthermic toxidromes including NMS and serotonin syndrome as well as their management.
Read MoreLast week our Journal Club focused on the treatment of hemodynamically significant pulmonary emboli. These are pulmonary emboli causing either frank hypotension (sometimes called massive or high risk PEs) or causing significant right heart strain as evidenced by CT findings, cardiac biomarker elevation, or bedside Echo findings. Drs. Grace Lagasse, Kari Gorder, and Claire O'Brien led us in a discussion of the 3 papers linked in the article. Read the papers yourself, listen to the podcast, read the summaries and get caught up on all things PE.
Read MoreThis week in Grand Rounds: lessons learned in mass casualty from our recent experience with a mass shooting, a case of abdominal pain in a patient with a TIPS, understanding the UA, the importance of diagnosing HIV in the emergency department, dental emergencies, point of care ultrasound in pediatrics, and a deep dive into the literature about management of low risk PE.
Read MoreAs 2016 comes to a close, Dr. McKean taught us about transfusion related lung injury, PEs, TCA overdoses, and the use of platelets in ICH during M&M. We learned the basics about the renal panel with Dr. Owens. Drs. Betz and Summers battled it out over drug-induced hepatitis and Dr. McKee taught us about Crypococcal Meningitis in her case follow-up. The year wrapped up with another Levy Cup Pre-season battle lead by Drs. Boyer and Winders.
Read MoreWe had another great week at Grand Rounds to wrap up the month of October. Dr. Betham ran the gamut of medical knowledge in her M&M, teaching us from organophosphate poisoning to rhabdomyolysis. Drs. Merriam and Curry battled in a CPC about submassive and massive PE. Dr. Shewakramani taught us about all things dental and Dr. Scupp brought it home with his soapbox about the importance of balance in IV fluid resuscitation.
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 MoreA 45 yo Female presents to the ED with sudden onset of chest pain, described as worse when taking a deep breath. She is significantly short of breath and appears distressed. She recently underwent a total right knee arthroplasty and reports having been bedridden secondary to pain. Physical exam is remarkable for a right lower extremity with surgical incisions that clean, dry, intact; however, her left lower extremity is swollen with significant tenderness along the popliteal fossa and calf.
Vitals: Temp 99.2HR 120RR: 28 BP: 130/80 SpO2 90% on RA.
A CTPA is ordered...
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.
