Grand Rounds Recap 2.7.24

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Grand Rounds Recap 2.7.24

Join us we recap another week of Grand Rounds. We start off with a CPC case, where Dr. Rodriguez challenges Dr. Benoit to a case involving a young child with recurrent syncopal episodes. Next up, Dr. Knudsen-Robbins teaches us all the tips/tricks to performing LPs in the ED. If you ever felt nervous about an pediatric airway, our airway expert, Dr. Carleton, walks us through all the nuances of a pediatric intubation. Meanwhile, Dr. Milligan reflects on her four years as a resident and shares her insight about making the hard decisions during training. One of our very own SRU tamers, Dr. Davis, teaches us how to expertly manage symptomatic bradycardia. Lastly, Drs. Broadstock and Ramachandran help us add nerve blocks to our growing toolbox used for treating acute pain in the ED.

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Grand Rounds Recap 7.26.23

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Grand Rounds Recap 7.26.23

This week we started off strong with the first Morbidity and Mortality of the academic year presented by Dr. Kletsel. This was followed by Dr. Smith’s R4 Case Follow up on the unique pathology of an LV thrombus. Dr. Jackson then takes us through methods for Taming the SRU and subarachnoid hemorrhages. Finally, we wrapped up with case-based discussions on opioid use disorder in the emergency department.

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CTs for SAH - Does Time Even Matter?

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CTs for SAH - Does Time Even Matter?

Spontaneous subarachnoid hemorrhage (SAH) is a can’t miss diagnosis for patients presenting to the emergency department with a headache. The diagnosis is associated with a 30% mortality at 30 days, and approximately 30% of survivors may have long-term neurocognitive deficits (Rincon et al., 2013). The majority of spontaneous SAH are secondary to a ruptured arterial aneurysm (80%) while non-aneurysmal SAH are often due to low pressure venous bleeds, arteriovenous malformations, and other more rare causes. This post will recap the existing literature on the diagnosis of aSAH and will focus on breaking down a recently published paper by Vincent, et al which may inform our future practice.

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Grand Rounds Recap 11/18

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Grand Rounds Recap 11/18

What do these 3 things have in common: interval prolongation, COWS, and rural America? All 3 were covered in this week’s UCEM Grand Rounds.

Dr. Li starting us off with monthly Morbidity & Mortality. Cards consultant Dr. Ahmad provided rapid fire EKG review. Dr. Stark refreshed us on opioid withdrawal treatment. And, Dr. Makinen delivered a moving capstone on the importance of rural emergency medicine.

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Grand Rounds Recap 3.29.2017

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Grand Rounds Recap 3.29.2017

Dr. Grosso kicked off Grand Rounds this week with March M&M by diving deep into some core content, including BB and CCA overdoses, influenza, massive transfusion, post-intubation hypotension, and neurological catastrophes causing cardiac arrest. Dr. O'Brien broke down coagulopathy of liver disease and DIC for us while Dr. Golden taught us about febrile seizures. Drs. McKee and Colmer talked through the evidence behind their CPQE pathway on vent management in obstructive lung disease. Drs. Liebman and Powell went head to head in a CPC case about sternal osteomyelitis to round out another excellent week of learning. 

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Grand Rounds Recap 03.15.17

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Grand Rounds Recap 03.15.17

This week, Dr. Boyer led us through his R4 case follow up. Drs. Baez and Summers dove deep into the literature on sepsis. Dr. Gauger reviewed toxicologic syndromes. Dr. Axelson hit us with some trauma pearls and we worked through sick respiratory cases during our combined Peds-EM sim. 

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Grand Rounds Recap 12/9/15

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Grand Rounds Recap 12/9/15

Glucose Emergencies

Remember the "I's" when looking for cause of DKA/HHS: Infection, Insulin lack, Infarction (MI, CVA, Ischemic gut), Indiscretion (EtOH, cocaine), Infant (pregnancy).

After 2L NS fluid bolus in the hemodynamically stable patient, the corrected sodium should guide fluid choice for further therapy.

Venous pH, HCO3 and base excess have sufficient agreement to be interchangeable with ABG in the ED.

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CSF Evaluation in Subarachnoid Hemorrhage

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CSF Evaluation in Subarachnoid Hemorrhage

So, what constitutes a “positive” tap when evaluating for subarachnoid hemorrhage?

Traditional teaching is that a positive tap is Xanthochromia or blood in the CSF

What exactly is Xanthochromia?

The word xanthochromia is simply Greek for “yellow color.”  It refers to the yellow color that CSF can take in certain situations.  Some of these situations are listed below:

  • Elevated CSF protein            
  • Jaundice
  • Hypervitaminosis A
  • Rifampin Therapy
  • Elevated Bilirubin
  • Oxyhemoglobin

What we are especially interested in when evaluating for subarachnoid hemorrhage is bilirubin and oxyhemoglobin.

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Neurologic Emergencies in the Air

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Neurologic Emergencies in the Air

Several months ago, I sat down and talked about the management of neurologic emergencies in the prehospital environment with Dr. Erin McDonough, an Emergency Physician and Neurointensivist who attends both in the ED and the Neurosciences ICU, and is a member of the Cincinnati Stroke Team.  In the brief podcast found below and on iTunes, we covered a wide range of topics including blood pressure management in spontaneous ICH, aneurysmal SAH, and ischemic stroke and some of the more rare complications associated with tPA administration.

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Isn't that CT Enough? - Water Cooler Breakdown of CT vs CT/LP for SAH

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Isn't that CT Enough? - Water Cooler Breakdown of CT vs CT/LP for SAH

Why Should You Care?

  • Headache approximates 2% of presenting complaints to the ED, and SAH is identified in approximately 1% of those patients with headache in the ED.
  • Overall mortality of SAH is high, estimated at 25-50% of patients dying within 6 months
  • If not fatal, SAH leaves approximately 33% of survivors with some appreciable neurological deficit affecting their ADLs.
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