Grand Rounds Recap 12.13.17

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Grand Rounds Recap 12.13.17

In the penultimate Grand Rounds of 2017 Drs. Klaszky and Spigner gave us an in-depth look of the evidence behind treatment of asthma in the ED and walked up through their new QI/KT pathway. Dr. Summers provided a great review of the resuscitation of the burn victim. We closed things out with our quarterly PEM-EM combined simulation sessions which included cases of children with difficulty breathing, seizure and stridor. 

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Grand Rounds Recap 5.24.2017

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Grand Rounds Recap 5.24.2017

Grand Rounds kicked off this week with Dr. Axelson's final M&M of the year where we learned about hypertensive emergencies, 2nd & 3rd trimester vaginal bleeding, the care of the sick asthmatic, which bronchiolitics can go home and how exactly to treat the many forms of UTIs. Drs. Kircher and Murphy-Crews continued the learning with a case follow-up about intubating patients with airway stents and pediatric head injury, respectively. Our joint EM-Peds lecture rounded out the day with visual diagnoses in peds. 

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Dealing with the Wheezes

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Dealing with the Wheezes

Asthma and COPD are 2 of the more common ailments responsible for patients presenting to an Emergency Department with complaints of shortness of breath.  Last week, we met as a residency and, led by Dr. Lauren Titone, Dr. Walker Plash, and Dr. Rob Thompson, discussed some newer literature for the treatment of these often intertwined conditions.  Take a listen to the podcast within to hear our thoughts and read the summary after the jump for the breakdown.

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Grand Rounds Recap March 30, 2016

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Grand Rounds Recap March 30, 2016

M&M with Dr. LaFollette

Modified Sgarbossa Criteria to aid in diagnosing STEMI in the setting of LBBB

  • Can be used in the setting of induced (paced) LBBB
  • Unweighted scoring (any of the following indicates STEMI equivilance)
    • Concordant ST elevation
    • Concordant ST depression in V1,V2,V3
    • Inappropriate discordance of >25% ST elevation / S wave amplitudes
  • Improves your test metrics from the original criteria from sens/spec of 36%/96% to 80%/99% respectively in a new validation study

 

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Grand Rounds Recap 9/30/2015

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Grand Rounds Recap 9/30/2015

September Morbidity and Mortality Conference - Dr. Toth

Cases reviewed were from the month of August. We saw greater volume in 2015 than 2014 with longer ED hold times. We reviewed multiple cases including:

Acute Inflamatory Demyelinating Polyneuropathy

  • Pain is a common presentation, and cranial nerve palsies are not infrequent, but they usually follow weakness and numbness of the extremeties.
  • The diagnosis is in large part clinical, with progressive areflexia and sensory loss being the hallmarks. CSF studies showing albuminocytologic dissociation is confirmatory.
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Grand Rounds Recap - 7/27/2014

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Grand Rounds Recap - 7/27/2014

M&M Learning Points with Dr. Stull:

  • Severe asthma exacerbations require considerable effort to avoid furthering acidosis while attempting to stabilize, secure airway, and maintain oxygenation. Use Mag early as there is evidence that you can reduce admissions by providing this treatment early. Consider BiPAP to improve ventilation while preparing for definitive airway management but there is no evidence that it reduces intubations. Ketamine as the RSI induction agent may provide some bronchodilatory effect but there is not enough data to provide any formal recommendations. For this same reason, ketamine as a post-intubation sedation agent may be appropriate. Vent management is key with a focus on low respiratory rate and short inspiratory times to lengthen the I:E ratio (>1:3) to allow full exhalation. Goal TV 6-8cc/kg, "ZEEP" or low PEEP (0-5mmHg), consider a plateau goal of ~25 if you paralyze
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