Grand Rounds Recap 08.12.20

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Grand Rounds Recap 08.12.20

This week’s Grand Rounds started off with Dr. Minges walking us through how to perform ultrasound-guided regional anesthesia. Drs. Curry and Ryan then presented the first Year Directives of the academic year discussing EMTALA criteria and how to negotiate a contract. Drs. Wosiski and Iparraguirre expertly discussed the literature behind angioedema management. Drs. Crawford and Doerning battled it out on a case involving hiccups (read to find out more about this fascinating case). And lastly, Dr. Stratton from our PEM division walked us through how to approach the pediatric patient and pearls on how to determine “sick” from “not sick".”

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Swelling out of the Blue - Angioedema in the ED

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Swelling out of the Blue - Angioedema in the ED

Angioedema is like urticaria in that both are transient swelling of well-demarcated areas. However, angioedema involves swelling of deeper tissues, producing nonpitting edema of the dermis and subcutaneous layers. It is most often seen in the eyelids and lips, and sometimes in the mouth and throat. While it is not pruritic it may be painful. In the US, angioedema accounts for approximately 100,000 ER visits annually (1). Across the world, 35% of prescriptions written for hypertension are for ACE-inhibitors (>40 million people). With a reported incidence of angioedema in 0.1–0.7% of those patients on ACEI, there are approximately 40,000 cases of ACEI-associated angioedema worldwide annually (2).

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Annals of B-Pod: Hereditary Angioedema

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Annals of B-Pod: Hereditary Angioedema

There are not many universal, unequivocal truths in medicine, but we can mostly agree that breathing is pretty important. It follows that diseases, injuries, or illnesses that interfere with our airways are problematic. Hereditary angioedema is a uniquely terrifying pathology in which the body’s inflammatory system is aberrantly activated, leading to swelling and collapse of a patient’s larynx. In this case, Dr. Shaw walks us through a presentation and management of a patient with hereditary angioedema in the emergency department.

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