Grand Rounds Recap 4.26.23
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Join us for a review of US in pregnancy by Dr. Frederick, Highs and Lows of residency with Dr. Comiskey, as well as reviews of in flight emergencies and high altitude emergencies
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Foot Injuries in the ED
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As an EM physician, it is important to have an understanding of the spectrum of foot injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive. Injuries discussed are shown in Image 1.
Read MoreTwisting and Turning - Ankle Injuries in the ED
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As an EM physician, it is important to have an understanding of the spectrum of ankle injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive.
Read MoreThe CLOVERS Trial
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Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. One of the primary pathophysiologic mechanisms involves complex cascade of host dysregulation in response to an infectious stimulus (Evans, Rhodes et al. 2021, Jarczak, Kluge et al. 2021). Recent meta-analyses and systematic reviews evaluating mortality in patients with septic shock reported mortality as high as 35% and 38% at 30 and 90 days, respectively (Vincent, Jones et al. 2019, Bauer, Gerlach et al. 2020). Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. 2022), ideally with antibiotics administered within one hour of sepsis recognition by the treating provider (Evans, Rhodes et al. 2021). Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al. 2022).
Read MoreAir Care Series: Epoprostenol/VELETRI: a Skybridge to Somewhere?
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Ever have that critical pneumonia ARDS patient that just cannot be safely transported without a temporizing (or longer) fix? Join Dr. Ferreri on a case study and deep dive into the physiology behind Epoprostenol use in Transport Medicine.
Read MoreGrand Rounds Recap 4.19.23
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This week we start off with Drs Davis and Paulsen in a CPC of an infected thyroglossal duct cyst. We then had two tox presentations on ethylene glycol poisoning as well as a trip through all those poisonous plants you knew once. Drs. Zalesky and Wosiski-Kuhn then take a trip around the latest research in EM!
Read MoreAcute Hyperthermia in the Emergency Department
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Often when we see elevated temperatures in the emergency department, our first instinct is to search for an infectious source. However, when body temperatures start exceeding 40.5 degrees, infection is a less likely etiology and there are a plethora of conditions that need to be considered.
Read MoreIV Metoprolol vs Diltiazem for A fib with RVR and Concomitant Heart Failure
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The management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction. The presence of HFrEF limits pharmacologic options for rate control. This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure
Read MoreFearsome Foliage - An Overview of Toxic Plants
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Spring has sprung... and so have many species of toxic plants! Poison centers across the United States receive over 100,000 reports of exposures to toxic plants annually. It is often difficult for Emergency Medicine providers to determine the quantity and time of exposure. Plant identification presents another challenge, and can even require the input of a botanist. Now that is an interesting consult! Thankfully, some of the more common and/or dangerous plant poisonings have been well-categorized, and are summarized in this post.
Read MoreGrand Rounds Recap 4.5.23
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This week we start off with Dr. Mullen’s lessons from morbidity and mortality conference. This is followed by R1 Dr. Vaishnav with a diagnostics talk on hyperthermia. Dr. Adan walks us through the always terrifying world of laryngectomy patients and finally guest lecturer Dr. Ray Bignall gives an excellent talk on disparities in medicine and how we address them
Read MoreAnnals of B Pod - Opioid-Associated Hearing Loss
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Unfortunately, we are all familiar with the dangerous respiratory depression that can occur in opioid overdose; but did you know that opioids can also cause hearing loss? Dr. Kein takes us through two cases of opioid overdoses with associated hearing loss, as seen in B Pod.
Read MoreUltrasound of the Month: Severe Hydronephrosis in a patient with Horseshoe Kidney
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This is not your average hydronephrosis… Join Dr. Olivia Gobble as she explores the sonographic and physiologic challenges presented by a horseshoe kidney.
Read MoreGrand Rounds Recap 3.29.23
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We are back with an excellent grand rounds session, where we heard about a case of resuscitative hysterotomy from Dr. Stark, BRASH syndrome, and HIV screening in the ED. We also heard some life lessons from the Peace Corps and how they relate to emergency medicine.
Read MoreGrand Rounds Recap 3.15.23
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What a packed week! We reviewed a harrowing case of massive bee envenomation (with insects in the airway) w/ Dr. Yates, R4 wisdom and philosophies with Dr. Mullen, an overview of hydrocephalus with Dr. Stothers, a CPC of a brain tumor presenting with aphasia with Dr. Glenn, a dive into hyperviscosity syndromes with Dr. Beyde, and a wonderful series of lectures on the Language of Being Well & Embracing Fear in EM with visiting professor Dr. Arlene Chung.
Read MoreDiastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?
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Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.
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