Grand Rounds Recap 7.21.21

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Grand Rounds Recap 7.21.21

Join us as Dr. Irankunda reflects on lessons learned throughout residency applied to a case of sulfonylurea toxicity, Dr. Winslow discusses multiple treatment modalities for refractory ventricular fibrillation, Dr. Benoit presents Cynefin Framework as a way to approach decision making in our disordered ED world, Dr. Zacharias discusses bicarbonate administration in acidosis, Dr. Adan discusses how to approach management and disposition for trauma patients in the community, and Dr. LaFollette challenges residents with a lower GI bleed in the Quarterly Simulation

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Grand Rounds Recap 10.28.20

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Grand Rounds Recap 10.28.20

Check out this week’s Grand Rounds Recap! Dive into colitis on CT via M&M with Dr. Koehler. Understand and treat cardiogenic shock with Drs. Kimmel and Broadstock. Share some laughs and learn about eyes with Visiting Professor Dr. Glaucomflecken. Disposition abnormal cardiac rhythms as seen in the community with Dr. LaFollette

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Trio of Trauma - Journal Club Recap

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Trio of Trauma - Journal Club Recap

The care of trauma patients is constantly evolving. From the time of injury to OR or ICU, there are dozens of management decisions that can improve the care and outcome for your patients. In our most recent journal club we took a look at 3 articles that looked at the management of trauma patients in the ED and ICU. Should we be adding vasopressin to our massive transfusion protocols? Is DL dead for trauma patients? Should we move to use IO’s early in traumatic arrests?

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Grand Rounds Recap 10/14

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Grand Rounds Recap 10/14

Reviewing our own neuroimaging just got a little easier with expertise shared by Dr. Knight. Trauma resuscitations just got a little more evidence-based with Journal Club covering VL>DL, IO>IV, and arginine vasopressin administration. Our kindness, attitude, and desire to take breaks all can improve with the help of Dr. Li’s R4 Capstone. Finally, Quarterly Sim/Oral Boards covered the spectrum of pediatric DKA with cerebral edema, to PTA, to trauma in the elderly, highlighting the breadth and depth of emergency medicine.

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Grand Rounds Recap 06.24.20

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Grand Rounds Recap 06.24.20

The final Grand Rounds of the 2019-20 academic year offered an incredible line up of lectures followed by an annual residency program evaluation and wrap-up by the outgoing chief residents, lovingly called “KJAM”.

Dr. Golden presented our monthly Morbidity and Mortality conference, full of cases to learn from and improve clinical care. Dr. Shaw presented his Taming the SRU lecture on a case of massive hemoptysis in an otherwise young and healthy patient. Dr. Murphy-Crews delivered a moving R4 Capstone lecture, demonstrating the low NNT for ED thoracotomies and highlighting that resilience is not the issue when it comes to burnout and physician suicide.

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Hypocalcemia in Trauma

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Hypocalcemia in Trauma

We are all familiar with the “lethal triad” of trauma – coagulopathy, hypothermia, and acidosis.  We have multiple methods wherein we attempt to prevent or reverse these physiologic derangements.  In particular, in recent years many teams have focused heavily on limited crystalloid infusions, increasing our early blood product transfusion (especially plasma), and early administration of tranexamic acid.

One of the main reasons we focus on these interventions is to address trauma-induced coagulopathy.  Trauma-induced coagulopathy has a multifactorial etiology and is contributed to by the other corners of the triad (hypothermia and acidosis).  However, one of the least appreciated contributing factors are electrolyte deficiencies, in particular calcium.

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Grand Rounds Recap 12.11.19

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Grand Rounds Recap 12.11.19

This week in grand rounds started off with Dr. Humphries reviewing the evidence of various interventions in traumatic cardiac arrest and providing a clear algorithm to follow in patients who suffer blunt traumatic cardiac arrest. We then had an in depth discussion on the approach to the encephalopathic patient in the Emergency Department. Dr. Bryant then presented some interesting cases that she had on her most recent trip to Guyana, followed by Dr. Ramsey’s in depth review of the emergent complications of acute leukemia. We finished off the day with our pediatric Emergency Medicine colleagues who led us through a simulation and oral boards cases.

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Grand Rounds Recap 10.02.19

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Grand Rounds Recap 10.02.19

In this week’s Grand Rounds we discussed spinal fractures and imaging of knees and hips with our R1s, Drs. Kimmel and Gressick. Dr. Hassani from the R2 class took on Dr. LaFollette with a case of thyrotoxicosis presenting as a-fib with RVR in his CPC, and Dr. Koehler from the R3 Class taught us about heroin/naloxone-induced pulmonary edema. Dr. Golden from the R4 class discussed Fournier’s Gangrene complicated by sepsis-induced cardiomyopathy, and finally our trauma surgery colleague Dr. Pritts discussed some hot topics in trauma.

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Is a Bag Enough?

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Is a Bag Enough?

Trauma scene flights are often the first thing people think of when they think of Helicopter EMS. Although we know that HEMS and Critical Care Transport involves much more than just scene flights, they are still a critical part of most HEMS programs’ mission and capabilities. In addition, many flights are “modified scenes” or “scene intercepts,” meaning the HEMS crew meets the EMS crew at an outlying hospital helipad, or arrives shortly after the patient’s arrival to an under-resourced ED. Many of these patients are critically ill, and a subset will require intubation and ventilation. Once intubated is bag valve ventilation enough? Or should all these patient’s be placed on a mechanical ventilator?

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

Damage Control Resuscitation, Permissive Hypotension, Fluid Restrictive Resuscitation… Regardless of name, with all the enthusiasm surrounding permissive hypotension in the actively bleeding trauma patient, what do we do when they have a TBI? Take a dive into the literature surrounding ideal perfusion pressures of patients suffering from TBIs and traumatic injury to find out if we know what pressure is really the best.

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Grand Rounds Recap 7.31.19

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Grand Rounds Recap 7.31.19

This week Dr. Kathryn Banning led us in our first Morbidity and Mortality conference of the year. Dr. Banning led us through robust discussion about concurrent pathology presentations, biases and more. Air Care Grand Rounds followed, in which we reviewed aircraft operations and logistics with the Air Care team and went through a simulation case that highlighted the importance of stress inoculation.

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Grand Rounds Recap 7.24.19

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Grand Rounds Recap 7.24.19

Grand Rounds this week started with our Leadership Curriculum, focusing on both positive and negative attitudes of leaders. Next, Dr. Hughes gave her Taming the SRU follow up lecture on debriefing and fat embolism syndrome followed by Dr. Spigner’s R4 Case Follow Up Lecture on streptoococcal toxic shock syndrome. The week wrapped up with simulation and oral boards practice covering acute right heart failure and anterior uveitis.

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Grand Rounds Recap 6.05.19

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Grand Rounds Recap 6.05.19

We hope you enjoy this week’s Grand Rounds Recap from 6.05.2019. We started the day with a talk on how to master the extraglottic device during Airway Grand Rounds with Dr. Carleton. Next, Dr. Liebman talked about error reduction in Airway Management with the use of checklists. Dr. Shaw then presented a fascinating case of Guillain-Barre Syndrome. Dr. Walsh shared some pearls as to how to utilize the Sgarbossa Criteria. Lastly, we were honored to have Dr. Dunlop talk to us about trauma in the developing world during Global Health Grand Rounds.

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Diagnostics: C-Spine Rules

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Diagnostics: C-Spine Rules

Clearance of cervical spine is more within the house of Emergency Medicine than anywhere else, so it implores that when we clear a cervical spine using our rules, we take a second to consider the sensitivity, specificity and even more importantly the exclusions that were used in the derivation and validations in these studies. Dr. Gawron takes a look through these rules for our review

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