Grand Rounds Recap 6.7.23

/
Grand Rounds Recap 6.7.23

This week Dr. Diaz starts off with a challenging case of massive upper GI bleed managed with balloon tamponade. We then moved into a case follow-up with profound electrical storm and recurrent ventricular arrhythmias secondary to a STEMI. Following this, we took a deep dive into waveform capnography regarding normal physiology and alterations with lung pathology with Dr. Wilson. Next, we had an exciting CPC showdown where Dr. Bryant successfully diagnosed Dr. Haffner’s case of valproic acid toxicity presenting with hyperammonemic encephalopathy. We closed with Dr. Wosiski-Kuhn outlining the difficulty of intubation in a patient with DKA and severe metabolic acidosis.

Read More

Grand Rounds Recap 7.21.21

/
Grand Rounds Recap 7.21.21

Join us as Dr. Irankunda reflects on lessons learned throughout residency applied to a case of sulfonylurea toxicity, Dr. Winslow discusses multiple treatment modalities for refractory ventricular fibrillation, Dr. Benoit presents Cynefin Framework as a way to approach decision making in our disordered ED world, Dr. Zacharias discusses bicarbonate administration in acidosis, Dr. Adan discusses how to approach management and disposition for trauma patients in the community, and Dr. LaFollette challenges residents with a lower GI bleed in the Quarterly Simulation

Read More

Grand Rounds Recap 02.17.21

/
Grand Rounds Recap 02.17.21

This week Dr. Koehler has great teaching points on epistaxis, PRES and more during M&M. Dr. McMullan recounts a harrowing tale of compassion in a case follow up. Dr. Wosiski-Kuhn gives a timely reminder on carbon monoxide and cyanide toxicities followed by Dr. Roblee’s acidotic arrest case and Dr. Lane wraps up with some business need-to-knows of EM.

Read More

What's in a Blood Gas? VBG vs ABG

/
What's in a Blood Gas? VBG vs ABG

You’re deep into a busy shift. Pushing yourself to see more volume towards the end of the year, you find yourself actively managing 8 patients.  You have 2 patients with difficulty breathing you believe have COPD exacerbations and 1 patient with a history of T1DM who has a critical high finger stick blood sugar and ketones in their urine.  You send VBGs as part of the work up for all these patients finding hypercarbia for the patients who have COPD exacerbations and a significant metabolic acidosis in the patient with T1DM confirming your diagnosis of DKA. You are in the process of admitting these patients when you face questions from your colleagues in-house as to why you didn’t perform an ABG on these patients?

Read More

What Makes an Airway Difficult

/
What Makes an Airway Difficult

What Makes an Airway Difficult? In short, a lot of different factors play into making an airway difficult.  In general, they can be broken down into anatomic, physiologic, and logistic.  We'll cover some of the logistical issues that can complicate intubations on a later post (mostly with regards to intubation in the HEMS and prehospital  setting).

Read More