As we continue our teleconferenced grand rounds, we started with a timely review of ARDS management and refractory hypoxemia with Dr. Shaw, two successful faculty guessed CPCs presented by Drs Irankunda and Pulvino and finally Dr. Jarrell gave us a much needed break with a baking show from her kitchen, with an included recipe for a mug cake!
Read MoreIf you have ever nodded along as someone described an MRI series weighting, you are not alone. As this modality becomes more accessible to the Emergency Physician, it is incumbent on us to familiarize ourselves with the critical aspects and critical diagnoses of MRI and how to speak the language. Dr. Zalesky takes us on a tour of the physics, indications and low-down of MRI from the ED.
Read MoreThe treatment of Acute Ischemic Stroke is a rapidly evolving field with critical care transport medicine playing an increasing role in the treatment of these patients. Dr. Irankunda explores CCTM specific management and historical musts when treating this unique patient population. Dr. Gottula provides a brief review of the literature supporting IV alteplase and endovascular thrombectomy.
Read MoreOver the past 5 years, there has been a dramatic expansion of the treatment strategies used to treat patients with acute ischemic stoke. As some of these treatments involve specific resources only available at certain institutions, appropriate triage of patients in the prehospital environment is becoming ever important. On one hand a patient who would best benefit from endovascular treatment triaged to a center without that capability will undoubtedly suffer a delay in care. On the other hand, over-triaging stroke patients to a comprehensive stroke center could overwhelm the resources of that center, potentially impacting the care of patients at that center. In the podcast below, we talk with Dr. Jason McMullan of the UC EM Division of EMS and Dr. James Li, PGY-3 who both have recent publications focusing on this phase of patient care.
Read MoreThis week Dr. Banning discussed several practice-changing topics in our Morbidity and Mortality conference. Drs. Laurence and Wolochatiuk prsented their QIKT project for the management of acute, decompensated pulmonary hypertension, and Dr. Wright gave a fascinating presentation on the approach to fever in a returning traveler.
Read MoreDizziness is common and is commonly a frustrating diagnostic dilemma in the ED. As patient’s stories vary between providers, it would be nice if we had a tool that was objective, reproducible and definitive. Enter - the HINTS exam. Join Dr. Ijaz as he discusses this nuanced exam that can change dizziness into a definitive diagnosis.
Read MoreWe had a great week in Grand Rounds. The first lecture included a debate about the use of rocuronium or succinylcholine in paralysis for intubation by Drs. Lang and Plash. Drs. Ryan and Moellman led a thrilling discussion through some of their most interesting and thought provoking cases of their careers. Pharmacists Nicole Harger and Paige Gaber then discussed updates in pharmacy, specifically the use of droperidol and anticoagulation reversal in the emergency department. We learned about cognitive biases and clinical decision making from Dr. Hill. The day wrapped up with Dr. Knight showcasing the NIH stroke scale with Dr. Foreman.
Read MoreJoin us as we review a number of fascinating pathologies in morbidity and mortality conference with Dr. Shaw. This is followed by Dr. Adeoye’s discussion of the history and controversy surrounding tPA. Check out the great discussion!
Read MoreWelcome 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!
Read MoreIn this week's grand rounds, Dr. Stolz discussed all things DVT and the modified two-point compression study for lower extremity clots. In our recurring EM-neuro combined conference, Dr. Stettler discussed the recent DAWN trial results, and how to incorporate CT perfusion studies into our acute ischemic stroke decision trees. In our Quarterly Sim, we discussed the management of the crashing patient from a house fire, and practiced our escharotomy skills. In our mock oral boards, we went through cases on STEMI, carbon monoxide exposure and limb ischemia. Finally, Dr. Lane discussed the workup of acute diarrhea in the adult population, and Dr. Shah went through a particularly unique toxidrome presentation in his R4 Case Follow Up.
Read MoreThis week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls. This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate. Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula. Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine. Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.
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 MoreThis week we had the distinct privilege to learn about empathy from Dr. Ope Adeoye who explored what empathy looks like from the patient's perspective - and why it's difficult to be truly empathic as a young physician. We puzzled over a CPC case of severe chest pain in a young woman. Dr. Harty taught us about the not-so-elusive TACO and TRALI among other transfusion reactions. Finally, Dr. Wurster-Ovalle gave us some pointers on management of unvaccinated children with fever in the ED.
Read MoreStroke Chameleons
Approximately 1 month ago we presented and talked through a particularly challenging patient flight scenario. As a refresher, if you don’t recall, check out the post here. Following the posting of the case, I sat down with ACMC Medical Director Dr. Bill Hinckley and Resident Assistant Medical Director for Air Care, Dr. Andrew Latimer, and recorded a podcast with their reaction to the case and to some of the curveball scenarios posed in the question and discussion section.
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.
