Grand Rounds Recap 3.9.22

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Grand Rounds Recap 3.9.22

In this week’s Grand Rounds, Dr. Gibler Visiting Professor and UCEM Alum, Dr. Chris Miller, shares his insight on emergency medicine leadership development and our role in healthcare’s evolution, Drs. Tillotson and Yates guide us through their evidence-based QI/KT protocol for hypertension evaluation and management in the ED, Dr. Sobocinski discusses the pathophysiology, presentation, and management of PRES and RCVS, and Dr. Wolochatiuk shares lessons learned and approach to bias in medicine during her R4 Capstone.

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Grand Rounds Recap 11.10.21

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Grand Rounds Recap 11.10.21

In this week’s Grand Rounds, Dr. Hassani theatrically illustrated the components of medical malpractice depositions with Dr. Walsh and important considerations for physicians in their preparation, Drs. Stevens and Gensic explored the differential for CBD dilation in their CPC, Dr. Shaw shared important considerations differentiating DKA and HHS and discussed asymptomatic hyperglycemia in the ED, and Dr. Laurence highlighted the differential for patients with HIV and AMS and the value in considering zebra diagnoses.

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Grand Rounds Recap 09.30.20

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Grand Rounds Recap 09.30.20

This week’s Grand Rounds was full of excellent cases, Bayesian statistics, and uncovered cognitive biases.

From Morbidity & Mortality Conference by Dr. Hughes, to airway expertise by Dr. Carleton, to tips to decrease stress by Dr. Koehler, to learned lessons from near misses by attendings Dr. Continenza, R. Thompson, and Sabedra, this summary is one you’re going to want to pay attention to!

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Grand Rounds Recap 11.20.19

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Grand Rounds Recap 11.20.19

Dr. Golden kicked grand rounds off this week with our monthly morbidity and mortality conference, followed by Dr. Lane’s deep dive on massive pulmonary embolism in cardiac arrest and how to approach this. Dr. Owens then gave us a detailed review on a probably-more-common-than-you-think parasite that has started popping up in the US, and our excellent ED pharmacists gave us a crash course on common antidotes to various poisonings, overdoses, and bites that we frequently see in the ED. Finally, Dr. Ham finished up with a review of the importance of chronic hypertension in our ED population and how we can make a difference especially those with limited access to care.

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Grand Rounds Recap 7.10.19

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Grand Rounds Recap 7.10.19

We had a great week in Grand Rounds. The first lecture included a debate about the use of rocuronium or succinylcholine in paralysis for intubation by Drs. Lang and Plash. Drs. Ryan and Moellman led a thrilling discussion through some of their most interesting and thought provoking cases of their careers. Pharmacists Nicole Harger and Paige Gaber then discussed updates in pharmacy, specifically the use of droperidol and anticoagulation reversal in the emergency department. We learned about cognitive biases and clinical decision making from Dr. Hill. The day wrapped up with Dr. Knight showcasing the NIH stroke scale with Dr. Foreman.

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The Thinker

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The Thinker

The reality of the Emergency Department is that not everybody is sick, but every patient could be sick. The task of finding the sick patients among the non-sick is far more challenging than it may appear and the diagnostic process is far more fraught with potential sources of error than one would like.

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Grand Rounds Recap 7.26.17

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Grand Rounds Recap 7.26.17

In this week's Grand Rounds, we led with our first Morbidity and Mortality conference of the year. Dr. Lagasse walked us through cognitive biases, the management of early obstetric emergencies, and the management of skin and soft tissue infections in the diabetic foot. In our leadership curriculum, Drs Hill and Stettler discussed the fundamentals of being a leader, and we got to hear from a panel of accomplished physicians within our department about their own leadership journey. Finally, in our Consultant of the Month series, Dr. Martha Ferguson discussed the management of ano-rectal conditions in the Emergency Department.

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A Healthy Dose of Fallibilism

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A Healthy Dose of Fallibilism
“Reason itself is fallible, and this fallibility must find a place in our logic.” - Nicola Abbagnano

Decision making in Emergency Medicine is intensely complex and it also the defining characteristic of the practice of Emergency Medicine.  To outside eyes we may seem to be a specialty of action: chest tubes, intubations, heroic resuscitations with massive amounts of blood products and IV infusions.  In truth none of the “action” of our specialty, the big sexy things they make into TV shows and movies, occurs without rapid, precise, and accurate thinking and decision making.  But the Emergency Department can be a hostile environment to the decision making process.   And, I’m not just talking about the noisy environment, the multiple interruptions, the patients with a wide variety of chief complaints and acuity seen in quick succession.  There’s seemingly a thousand different hurdles between the instant a patient recognizes that something might be wrong with them and the moment a clinician diagnoses the problem. 

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Grand Rounds Recap 7/6/2016

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Grand Rounds Recap 7/6/2016

This week we got an operations update with some new markers of quality and new guidelines on HIV testing. We were reminded about patient literacy and the advantages of keeping it simple. Dr. Hill also taught that every shift our biases and decision making do affect patient care, it is our duty to recognize and use them to our patients' advantage.

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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 2/3/16

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Grand Rounds Recap 2/3/16

This week we had our annual Critical Care Symposium where we invited our own critical care trained faculty and a special guest to have a day chock full of critical care goodness.

Refractory septic shock with Dr. David norton

Dr. David Norton, Assistant Professor of Medicine and Director of the UCMC Medical Intensive Care Unit

Definition of Refractory Shock:

No clear definition exists, but we are generally describing a state of decreased vascular responsiveness despite high vasopressor infusion.

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The Cognitive Autopsy

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The Cognitive Autopsy

We are in a thinking profession.  

An outsider looking in on our profession may see procedures and action as the defining characteristics of the practice of Emergency Medicine.  But, reflecting on the attributes of the best EM docs I’ve worked with, their procedural excellence isn’t what stands out.  Thinking back on the great physicians I have met and worked with, the ones I strive to be like every day, it is their ability to think, lead, and educate that sticks with me the most.  

And, it turns out I’m not the only one who might see it like this…

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Lessons in Transport - Cognitive Biases in Critical Care Transport

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Lessons in Transport - Cognitive Biases in Critical Care Transport

As critical care transport professionals we are often perceived as an action oriented specialty. We frequently pride ourselves on procedural excellence and efficiency. (a difficult intubation, or fast scene-time etc.) However, the reality is that we spend the vast majority of our patient care time engaged in cognitive behavior... in THINKING rather than acting!

Because of this, it is imperative that we make every possible effort to understand how we think while caring for others. In addition, we should be aware of some of the cognitive biases that threaten our thinking processes, decision making, and thus the patients who place their trust in us.

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