Annals of B Pod: Acute Globe Subluxation
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In our next Annals of B Pod Case - join us for the management and tips on how to keep your nerve and reduce the eye and set everyone at ease.
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Grand Rounds Recap 6.28.23
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For our first grand rounds of the academic year, Dr. Paulsen challenged us with her Admit/Discharge/Transfer lecture which made us ponder the disposition of several difficult cases. This was followed by a case-based and interactive discussion on how to break bad news to patients in the ED by Dr. McDonough. Last but not certainly not least, our Department Chair Dr. Pancioli took us through the past, present, and future of EM, it’s triumphs, and potential threats to the way we practice.
Read MoreHunting for Invasive Bacterial Illness in Infants with a Positive UA
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The workup of febrile infants (<60 days) can be extensive and invasive. This post and podcast covers a recent paper by the PECARN research group that sought an answer to the question: What is the prevalence of bacteremia and/or bacterial meningitis (“invasive bacterial illness”, ISI) in febrile infants ≤60 days of age with a positive urinalysis (UA) result?
Read MoreRiding the Waves: End-Tidal CO2 Monitoring
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End-Tidal CO2 monitoring has a variety of uses in the Emergency Department. Whether used diagnostically or for monitoring of a patient’s physiology, clinicians must possess an understanding of the information that you can gather from EtCO2 waveform tracings. Knowing how to interpret the waveforms makes EtCO2 much more than a number, allowing the clinician to gain insight into minute to minute changes in a patients physiological state.
Read MoreGrand Rounds Recap 6.21.23
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This week’s grand rounds starts off strong with the last Morbidity and Mortality of the year presented by Dr. Zalesky. This included multiple stimulating cases including meningitis, procedural safety, acute aortic syndromes, hemophilia, electrical storm, and euglycemic DKA. Finally, we wrap up the day with a lecture on the science behind wellness with Dr. Martella.
Read MoreGrand Rounds Recap 6.7.23
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This week Dr. Diaz starts off with a challenging case of massive upper GI bleed managed with balloon tamponade. We then moved into a case follow-up with profound electrical storm and recurrent ventricular arrhythmias secondary to a STEMI. Following this, we took a deep dive into waveform capnography regarding normal physiology and alterations with lung pathology with Dr. Wilson. Next, we had an exciting CPC showdown where Dr. Bryant successfully diagnosed Dr. Haffner’s case of valproic acid toxicity presenting with hyperammonemic encephalopathy. We closed with Dr. Wosiski-Kuhn outlining the difficulty of intubation in a patient with DKA and severe metabolic acidosis.
Read MoreMastering Minor Care: Dog Bites
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Don’t worry I’m a DOG-ter! Join Dr. Yates for a deep dive into dogbites covering which wounds to repair, when to consider antibiotics and whether a rabies vaccine is indicated.
Read MoreEtCO2 vs. Standard Triage Vitals in Predicting In-Hospital Mortality and ICU Admission
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Boarding of admitted patients in the ED and subsequent overcrowding of ED’s continues to plague hospitals in the United States and Internationally. The Covid-19 pandemic exacerbated an already growing problem regarding capacity management and patient flow. In this current climate, the Emergency Physician’s responsibilities continue to shift toward the front-end of the process, mainly patients waiting to be seen in the lobby. As such, identifying sick patients in a timely manner and utilizing additional resources to predict patients at risk of clinical deterioration will be paramount moving forward.
Read MoreGrand Rounds Recap 5.10.23
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This week we start off with an exciting CPC showdown between Drs. Chhabria and Baez, followed by a new proposed pathway for the diagnosis and treatment of Carbon Monoxide Poisoning by Drs. Moulds and Wright. Next, the pediatric department reviewed “one pill can kill” for our pediatric populations, and finally we heard from Dr. Frank about competency in medicine and medical education.
Read MoreGrand Rounds Recap 5.3.23
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Join us to recap our Grand Rounds session from the first week in May. Starting with the April M&M report expertly delivered by Dr. Broadstock- featuring atypical ACS, as well as the aggressive management of a CCB overdose. Followed by Dr. Mullen taking us through a set of cases involving near misses, as she reflects on things she learned during her four years in residency. Next up, Dr. Hajdu educated us about the presentation, pathophysiology, and evidence-based management of mild TBI’s/concussions in the ED. Lastly, we finish off with Air Care GR featuring details about the TOWAR study, review of management of pediatric seizures, as well as tips & tricks to improve our flight-related documentation.
Read MoreGrand 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
Read MoreFoot 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.
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