Grand Rounds Recap 11.20.19

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Grand Rounds Recap 11.20.19

Dr. 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.

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Grand Rounds Recap 10.16.19

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Grand Rounds Recap 10.16.19

This week we disccused interventions for the crashing asthma patient with Dr. Mand, ESRD and dialysis related complications with Dr. Scanlon, shoulder and elbow xrays with Drs. Crawford and Scanlon, and a case of intussusception in an adult patient with Drs. Hunt and Bryant. Dr. Gauger provided his case follow up on PJP pneumonia complicated by methemoglobinemia, and Dr. Li took us through the ins-and-outs of gastric lavage in a simulated case of calcium channel blocker overdose.

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Sepsis Journal Club Roundup

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Sepsis Journal Club Roundup

The management of patients with sepsis can be exceptionally complex. As with many patient’s with complex critical illnesses, often times attention to seemingly minor aspects of the patient’s management can have significant impacts on the patient’s course of illness. In this recap of our most recent journal club, we review 3 such aspects of the care of patients with sepsis. Does the type of IV fluids really make a difference? Are steroids a friend or foe in the care of these patients? And can the simple bedside assessment of capillary refill replace serial measurements of lactate?

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The A Fib Chicken and Egg - III Recap

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The A Fib Chicken and Egg - III Recap

This is the first in a series of 3 blog posts recapping our residency’s most recent asynchronous small group exercise.  For these posts, we’ll start with a case vignette and then highlight some key aspects of the presentation and cover some key learning points. You can also take a listen to the accompanying podcast for a slightly more in depth look at the case.

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Grand Rounds Recap 3.27.19

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Grand Rounds Recap 3.27.19

Enjoy this week’s Grand Round’s Recap. Dr. Murphy started us off with a great Morbidity and Mortality conference with a variety of fascinating cases. Next, Dr. LaFollette taught us some pearls for HEENT emergencies if you are out in the community. Dr. Hunt took us through transfusion reactions and how to manage them, followed by Dr. Hall discussing the management pearls of Nonconvulsive Status Epilepticus. Next, Dr. Connelly taught us how we can incorporate alternative EKG leads into our practice, and Dr. Klaszky finished our day with a nuanced take of how to manage refractory septic shock. It was a jam packed day full of great learning!

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Air Care Series: Sepsis Update

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Air Care Series: Sepsis Update

Katherine Connelly, MD reviews the literature surrounding the definition and management of sepsis both in the Emergency Department and Critical Care Transport Environment. We will cover pressor usage, as well as appropriate antibiotic coverage and if there is any role for steroids (for now…)

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Grand Rounds Recap 12/12/18

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Grand Rounds Recap 12/12/18

This was an exciting week of Grand Rounds discussions on a variety of topics. We began with a discussion of prehospital sepsis care and an update on EMS protocols in Southwest Ohio. The combined EM-Neuro conference provided a lively discussion on Guillain-Barre syndrome. The quarterly operations update was followed by a detailed discussion on esophagitis management in the ED. Finally, the pediatric fellows led a series of case discussions on a variety of devastating pediatric illness.

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Air Care Orientation Case #4

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Air Care Orientation Case #4

May brought the fourth case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack.  This month, a case of sepsis.  Should we just transfer the patient as quickly as possible, or are there other things we should do first?  Read on to find out!

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Grand Rounds Recap 3.28.18

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Grand Rounds Recap 3.28.18

This week's Grand Rounds opened with Dr. Ludmer giving Morbidity and Mortality conference. Sports Medicine Dr. Betz then took on the common chief complaint of ankle pain, and described the evidence-based management and common ankle sprain mimics. Dr. Shaw discussed basics on tracheostomies and Dr. Renne closed out Grand Rounds with his approach to the judicious use of IV fluids in septic shock. 

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Grand Rounds Recap 1.24.18

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Grand Rounds Recap 1.24.18

This 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.

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Grand Rounds Recap 11.29.17

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Grand Rounds Recap 11.29.17

This 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.

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Pro's and Con's of Procalcitonin

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Pro's and Con's of Procalcitonin

Procalcitonin was reviewed on Taming the SRU in the context of other biomarkers (ESR, CRP) last year with a grand rounds discussion of its utility in the setting of a febrile 7 week old. As procalcitonin has continued to gain traction in the world of pediatric EM – receiving evaluation as part of proposed protocols for management of febrile infants (1) and for its utility as an aid to diagnosis of Serious Bacterial Infection (2,3) – we turned our attention this year to procalcitonin’s use in adults. Procalcitonin testing has been studied and available for decades (as St. Emlyn’s noted in an update earlier this year), but has not really established itself in widespread use in adults (as EMDocs noted in a sepsis update in 2014). In this blog post, we take the approach of going back to what is known (and is NOT known) about the biochemical basics of this molecule to give context to the sometimes confusing smorgasbord of proposed applications for procalcitonin testing that exists in the literature.

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Grand Rounds Recap 8.9.17

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Grand Rounds Recap 8.9.17

This week's Grand Rounds began with Quarterly Sim led by Dr. LaFollette who walked us through a case of cardiogenic shock and neutropenic fever. Dr. Curry led us through an oral boards triple case with an unstable MCC, a FB ingestion and perforated viscous. Dr. Hill presented an eOrals case of thyroid storm. Lastly was PEM-EM combined conference, led by Dr. Wurster Ovalle, which focused on the treatment of pediatric DKA with a special focus on cerebral edema. 

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Vasopressin: A Second Class Pressor?

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Vasopressin: A Second Class Pressor?

This week we'll be recapping the discussion of our most recent journal club where Dr. Christian Renne, Dr. Anita Goel, and Dr. Maika Dang led us in a discussion centering on the use of vasopressin both in sepsis and in vasoplegic shock states.  Take a listen to the podcast below and read the brief summaries of their articles to boost your understanding of Vasopressin.  Should you reach for it first or is it a second class pressor?

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