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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Grand Rounds Recap 9.28.22

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Grand Rounds Recap 9.28.22

This week we had a tour de force of education goodness. We started off with Dr. Mullen presenting Morbidity and Mortality Conference. This was followed with an updated DKA QI/KT protocol developed by Dr. Shaw and Dr. Glenn. More great faculty Core Content was brought by Dr. Irankunda elucidating high pressure injection injuries. We wrapped up the day with some research nuggets with Dr. Freiermuth.

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Grand Rounds Recap 3.30.22

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Grand Rounds Recap 3.30.22

Join us as we cover the true breadth of our specialty during this week’s Grand Rounds! Starting from an excellent, ultrasound-loving Morbidity and Mortality Conference with Dr. Walsh, we discuss end of life care in the ED as well as atypical agents for symptomatic relief with visiting professor Dr. Karen Jubanyik, identify and manage hernias of all types during Dr. Brower’s R1 Clinical Knowledge lecture and end with an inspiring talk on imposter phenomenon with Dr. Pulvino in her R4 Capstone.

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PERCs of the Wells Score

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PERCs of the Wells Score

Pulmonary embolism (PE) is one of the big “can’t miss” diagnoses in the emergency department. Unfortunately, presenting symptoms are often vague, and definitive diagnostic testing is expensive and comes with risks of radiation and contrast to the patient. In order to avoid missing a PE while mitigating the risks associated with overtesting, some clinical decision tools have been created to aid in the diagnostic process. We will focus on two of these commonly used decision tools: the PERC rule and the WELLS score for PE.

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Grand Rounds Recap 9.26.18

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Grand Rounds Recap 9.26.18

This weeks grand rounds started off with our Morbidity and Mortality conference led by Dr. Shaw who led us on an education expedition covering the use of REBOA, surgical vs. medical management in spontaneous miscarriage, ways we can improve our use of the electronic medical record, management of a persistent air leak in a patient with a chest tube, and the role of CT in CAP. Dr. Alwan then provided us an in-depth look at the often untold challenges of life as a refugee as well as the challenges we face in providing care for these patients. This was followed by Dr. Randolph who presented a case of an incredibly complicated patient with a pulmonary embolism to highlight the steps in management of a decompensating patient with a pulmonary embolism before you initiate thrombolysis. Next up was Dr. Gottula and Dr. Hinckley who went head to head with a challenging presentation of acute aortic dissection as part of our CPC lecture series. Dr. Leech then finished up the day with a case based discussion on the utility of the Kocher Criteria in the evaluation of child with an acutely painful hip.

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A Significant Clot

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A Significant Clot

Last week our Journal Club focused on the treatment of hemodynamically significant pulmonary emboli.  These are pulmonary emboli causing either frank hypotension (sometimes called massive or high risk PEs) or causing significant right heart strain as evidenced by CT findings, cardiac biomarker elevation, or bedside Echo findings.  Drs. Grace Lagasse, Kari Gorder, and Claire O'Brien led us in a discussion of the 3 papers linked in the article.  Read the papers yourself, listen to the podcast, read the summaries and get caught up on all things PE.

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Clinical Concepts in CT Imaging of the Chest

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Clinical Concepts in CT Imaging of the Chest

A 45 yo Female presents to the ED with sudden onset of chest pain, described as worse when taking a deep breath.  She is significantly short of breath and appears distressed.  She recently underwent a total right knee arthroplasty and reports having been bedridden secondary to pain.  Physical exam is remarkable for a right lower extremity with surgical incisions that clean, dry, intact; however, her left lower extremity is swollen with significant tenderness along the popliteal fossa and calf.  

Vitals: Temp 99.2HR 120RR: 28 BP:  130/80 SpO2 90% on RA.

A CTPA is ordered...

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