Is Your Head Spinning? The Sudbury Vertigo Risk Score

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Is Your Head Spinning? The Sudbury Vertigo Risk Score

There is a wide variation in practice, particularly in obtaining neuro-imaging in patients presenting with vertigo. Many patients are imaged and subjected to a longer length of stay, and on the other side of the coin, some patients with serious pathology fall through the cracks. The authors of this study set out to create a risk score to apply to patients who present to the ED with vertigo which would identify the patients at risk for serious pathology (which they defined as stroke, TIA, vertebral artery dissection, or brain tumor).

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Grand Rounds Recap 04.15.20

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Grand Rounds Recap 04.15.20

We had another exemplary installment of Grand Rounds this week that started with Attending Case Followup with Drs. Lang, Baez, and Paulsen. Then we had some top-notch review of core curriculum with Dr. Winslow and the Alvarado Score for appendicitis, Drs. Meigh and Klaszky on food impactions and esophageal foreign bodies, and Drs. Comiskey and Nagle on D-dimer. Finally, Dr. Nagle gave us an overview of the foundations of evidence-based medicine with his R4 capstone.

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Intrathecal Baclofen Withdrawal

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Intrathecal Baclofen Withdrawal

Intrathecal baclofen withdrawal is characterized by increased spasticity, hypertension, tachycardia, hyperthermia, altered mental status, and seizures. In the most severe cases, autonomic instability, rhabdomyolysis, diffuse intravascular coagulopathy, multisystem organ failure, and death can occur.  In this episode of the research corner, we cover a recently published case report where intrathecal baclofen withdrawal was treated successfully with dexmedetomidine.

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Grand Rounds Recap 8.8.18

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Grand Rounds Recap 8.8.18

This week started with a discussion on how we can improve our documentation to maximize our level V billing. This was followed by a summary of practice changing literature over the last year, a discussion on how we deal with failure in the clinical setting, and a guide to the approach of the agitated pediatric patient. Finally, we broke into small groups to learn about ENT emergencies.

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Grand Rounds Recap - 3/11/15

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Grand Rounds Recap - 3/11/15

Health Care Disparities with Dr. Ford

There is a well established distrust of the medical system by minorities, especially African Americans. The historic causes of this distrust are widespread and seen in nearly all stages of American Healthcare. A great resource is Medical Apartheid by Harriet Washington. Some key examples of the use of AA in medical advances: 

1800s: Slaves referred to as "clinical material" in medical schools and journal publications. Slave bought and used for experiments and experimental surgeries including the first successful vesicovaginal fistula repair (caused by forcep deliveries) which was done without anesthesia. 

1900-1930: "malaria therapy" with fatal falciparum used to try and treat syphilis. Tuskeegee experiments- subjects recruited under false pretense of "free testing and medical treatment" for syphilis experiment with no intention to treat despite PCN being widely available. "The future of the negro lies in the research laboratory..." Patients were offered a free burial when they died from the disease so that an autopsy may be performed. "as I see it, we have no further interest in these patients until they die..."

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Grand Rounds Recap 1/7/14

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Grand Rounds Recap 1/7/14

CPC with Dr. Boyer vs. Dr. Steuerwald

16yoF with 4 days of bilateral lower quadrant abdominal pain and diarrhea that was tachy, dry, and with a diffusely tender abdomen and some right-sided discomfort on pelvic exam with a mild leukocytosis.

Dr. Steuerwald's approach to listening to patient presentations: Pick out the main symptoms, get a time course, and listen for any other true "weirdness" then build your own timeline of events.

  • Don't forget about the "sexy numbers" in everyone, these include the vitals and also key aspects of a disease process (i.e. the EF in a patient with CHF)
  • DDx included appendicitis, PID, TOA, Fitz-Hugh Curtis, Ovarian Torsion, Yersinia enterocolitis
  • Dr. Steuerwald correctly identified the need to get a RLQ US to assess for appendicitis!
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Grand Rounds Recap - 9/24/2014

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Grand Rounds Recap - 9/24/2014

Management of the GI bleed (a review of the Cochrane Reviews): 

  • PPI drips have been shown to decrease the rate of rebleed in patients with known peoptic ulcers. It has not been shown to decrease mortality, hospital stay, transfusion need. It also has not been shown to be beneficial in the undifferentiated upper GI bleed and may have a trend toward harm. 
  • Octreotide doesn't improve mortality but on average decreased transfusion requirement by 1/2u product.
  • Antibiotic coverage (treating for gut translocation with ceftriaxone) has been shown to have lowered mortality from infection and all-cause mortality.
  • Prophylactic intubation: 2 retrospective chart reviews came up with contrasting results on mortality outcome after intubating for prophylactic reasons (patient was protecting their airway). 
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A Crack in the Ice? An In-Depth Breakdown of the TTM Trial

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A Crack in the Ice? An In-Depth Breakdown of the TTM Trial

   Like many other Emergency Medicine residencies, we took the time in our last Journal Club to break down the Targeted Temperature Management Article.  There is tons out there in the #FOAMed space about this trial.  And, one of our 4th year residents, Dr. Trent Wray, took some extra time to break down the article in gory detail and put it into the context of the previously published literature.

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The Basics of Evidence Based Clinical Practice - Asking Good Questions

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The Basics of Evidence Based Clinical Practice - Asking Good Questions

Evidence Based Clinical Practice (EBCP) is a way to bring the sometimes obtuse world of evidence based medicine to the bedside.  Instead of getting lost in p-values, ANOVA, student t-tests, multivariate logistic regressions, EBCP approaches evidence based medicine always through the lens of a patient under a clinician's care.  It is a process that starts with asking carefully crafted questions and efficiently searching for answers to those questions.  Subsequent analysis of the articles found in the clinician's searching seeks to answer: are the results valid? what are the results? and finally, how can one apply the results to patient care?

In this short video, we go through the crucial initial step of the process: asking a question.  Success in asking answerable, well crafted questions begets successful search strategies.

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