The Lever Test for Diagnosing ACL Injuries

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The Lever Test for Diagnosing ACL Injuries

The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligaments, with nearly 200,000 injuries annually in the US, with ~100,000 requiring reconstruction. The ACL prevents anterior translation of the tibia relative to the femur and is a secondary restraint to tibial and varus/valgus rotation. Accurately diagnosing ACL injuries in the ED after an acute knee injury remains difficult. The diagnosis is complicated because clinical tests are performed on an acutely injured knee, which is likely swollen and painful, leading to muscle contractures and patient apprehension. As Emergency Medicine physicians, we must have some confidence in suspicion of an ACL tear because not all patients can or should be referred for prompt orthopedic follow-up. 

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Grand Rounds Recap 10.4.23

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Grand Rounds Recap 10.4.23

This week’s Grand Rounds kicked off with a series of involved cases including endocarditis strokes, Tasotsubo cardiomyopathy and more. Dr. Freiermuth gave us an update on the landscape of research and move to adaptive designs. Drs. Sookdeo and Diaz gave talks on RCVS, PRES and compartment syndrome for some core content.

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Diagnostics and Therapeutics: Managing Pneumothorax

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Diagnostics and Therapeutics: Managing Pneumothorax

There are many different types of pneumothorax (PTX), and the management paradigm has shifted in recent years as the research has exploded on this topic. This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Institutional resources and specialty services may further dictate the management of PTX. This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department.

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Grand Rounds Recap 9.27.23

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Grand Rounds Recap 9.27.23

It was a stellar week here at UCEM Grand Rounds! We kicked off the day with a lecture from our colleague at CCHMC, Dr. Dean, about management of pediatric airways. We then transitioned to a review of landmark studies in EM, specifically with regards to targeted and systemic thrombolysis for MI, stroke, and PE. We continued our day by discussing evidence based medicine and the implementation of this in the prehospital setting with EMS faculty, Dr. Richards. Next, Drs. de Castro and Thompson faced off in an epic battle of CPC where we covered the diagnosis and management of euglycemic DKA. This was then followed by Dr. Vaughan’s R1 diagnostics and therapeutics lecture on pneumothoracies. Finally, we wrapped up the day with Dr. Gillespie’s R4 capstone lecture.

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Twists and Turns: Identifying Maisonneuve Fractures in the ED

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Twists and Turns: Identifying Maisonneuve Fractures in the ED

A Maisonneuve fracture is a specific ankle fracture pattern that involves the medial malleolus, syndesmosis and proximal fibula. It can be easily missed if a provider does not routinely evaluate the proximal fibula as part of their ankle examination, as x-rays of the ankle can often appear normal. Disruption of these structures yields an unstable ankle fracture, thus making close follow up for operative management imperative. It is key to identify this fracture when patients present to the Emergency Department with ankle injuries to ensure definitive management and prevention of complications down the line. 

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Grand Rounds Recap 9.20.23

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Grand Rounds Recap 9.20.23

Another excellent week for UCEM Grand Rounds! We started the day with an introduction to universal HCV screening in the ED from our pharmacy colleagues. We then transitioned to a great discussion on concussions sports medicine faculty Dr. Gawron. Next, Dr. Guillaume led us through diagnostics and therapeutics for nonconvulsive status epilepticus. Then, Dr. Shaw presented two cases of PRES and the importance of recognizing this diagnosis. Finally, R4s led the way through a simulation on adrenal insufficiency as well as structured oral boards case practice.

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Has Video Finally Killed DL?

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Has Video Finally Killed DL?

More than 1.5 million adults undergo tracheal intubation outside of the operating room each year in the United States. Traditionally, this has been performed with direct laryngoscopy, where a clinician displaces the patient’s tongue and epiglottis with a laryngoscope blade to visualize the vocal cords through the mouth, allowing for direct visualization of the passage of an endotracheal tube. An alternative method for tracheal intubation is video laryngoscopy, where a camera on the distal half of the blade transmits an image to a screen allowing for indirect visualization of the vocal cords and passage of an endotracheal tube without direct line of site.

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Induction Reduction?

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Induction Reduction?

Rapid sequence intubation (RSI) is frequently performed under emergent conditions in acutely ill patients. RSI is a technique for managing the emergency airway that induces immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent). In properly selected patients, it is a quick, safe, and effective approach that results in optimal intubating conditions. However, one of the feared complications of RSI is post-intubation hypotension leading to cardiovascular collapse. Although there are multiple possible reasons for hypotension post-intubation, the choice and dosing of induction agents has been implicated.

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Grand Rounds Recap 9.13.23

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Grand Rounds Recap 9.13.23

Join us to recap another week of UCEM Grand Rounds! We start with a quick hits EKG lecture with Dr. Baez, focusing on common EKG findings associated with electrolyte abnormalities. Dr. Tillotson teaches us how to set up inhaled therapies for our critically-ill patients, while thousands of feet in the air! We then turn to Dr. Chang and learn how to expertly treat pain and perform procedural sedation on the smallest of patients we encounter as emergency physicians.

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Grand Rounds Recap 9.6.23

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Grand Rounds Recap 9.6.23

Join us for a review of another fantastic week of Grand Rounds. We start with Dr. Minges expertly guiding us through performing DVT studies in the ED, to help us better address the needs of the patients in front of us. Dr. Kreitzer presents the data, as well as and personal experience, to passionately advocate for including family members in the ED and ICU’s- including procedures, resuscitation, rounds, and multidisciplinary meetings. Meanwhile, Dr. Onuzuruike refreshes our foundation knowledge pertaining to AICD’s in the ED. Lastly, Drs. Negron and Wright reflect on their expertise as leaders in the SRU to teach us all about managing the most difficult airways- including intubating through the nose and even an supraglottic device.

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Grand Rounds Recap 8.16.23

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Grand Rounds Recap 8.16.23

Join us to summarize another fantastic series of Grand Rounds lectures. We start off with in-flight emergencies, including changes to physiology and what equipment is available to you on most commercial flights, with Dr. Urbanowicz. Followed by a literature-filled debate between Drs. Lane and McDonough on the utility of CT pan-scans in trauma patients. With the help of Dr. Shewakramani, we all learn how to better recognize and care for patients with sepsis. Meanwhile, Dr. Roche teaches us about all various bites/stings- including marine species, scorpions, and mosquitos! Lastly, Dr. Wright introduces us to the science of reliability and how to design processes in healthcare to be more reliable, with the ultimate goal of improving our care of patients.

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Grand Rounds Recap 8.30.23

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Grand Rounds Recap 8.30.23

We start off strong this week with EMS grand rounds, where EMS fellow Dr. Klein walks us through potential uses and barriers for using ultrasound in the prehospital setting. We then moved on to our R1 Diagnostic and Therapeutics lecture, where Dr. Segev expertly led us through a discussion on the use of inflammatory markers in the ED including several small group cases. Next, an exciting CPC matchup between Drs. Schor and Stolz who went head to head to discuss a mysterious case of the hiccups. This was followed by Dr. Diaz who gave her R4 Capstone lecture on what her R4s taught her. Finally, we wrapped up the day with an excellent discussion on airway management during our airway grand rounds.

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Grand Rounds Recap 8.9.23

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Grand Rounds Recap 8.9.23

Join us as we recap our last week of Grand Rounds, including our first intern lecture of the year focusing on pericarditis & myocarditis. Learn about the art of skillfully resuscitating a patient with an LVAD, as well as the tips/tricks for effectively communicating with patients, from our senior residents. Learn how to confidently handle ENT emergencies in the community and orthopedic trauma in a limited-resource settings. Our pharmacy colleagues gave us an timely update on use of Precedex in the ED, as well as Andexxa vs. PCC for reversal of Xa-inhibitors. Lastly, our pediatric EM colleagues joined us to discuss to subtle difference in diagnosis and management of neonatal & pediatric seizures compared to adults.

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