Diagnostics and Therapeutics: Hypothermia
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Dr. Boyer walks us through nuances and management of the highly morbid condition of severe hypothermia.
Read MoreGrand Rounds Recap 3.20.24
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We had an exciting Grand Rounds this week! Dr. Ben Bassin, a UCEM alum and our visiting lecturer from the University of Michigan, started off strong discussing innovation in emergency care delivery. He discussed modeling and design of modern emergency departments and our upcoming Flex ICU. Dr. Grisoli then shared an exciting resuscitation of a profoundly hypothermic cardiac arrest. We split off into small groups for simulation and oral boards covering tuberculosis, meningitis and the RV spiral of death.
Read MoreGrand Rounds Recap 11.30.22
/This week, we were joined by Dr. Gorgas from OSU to discuss ethics in global health, heard about evidence-based medicine from Dr. Zalesky, used gamification to review winter topics with Drs. Wosiski, Diaz, and Stark, and held our M&M conference.
Read MoreAir Care Series: Accidental Hypothermia
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Stuck in the Polar Vortex? Consider this. Hypothermia often requires unique approaches to the traditional management of classic pathology in the critical care transport environment. Take a deep dive into the classifcation and management of patients suffering from accidental hypothermia - from rewarming to cardiac arrest management and ECMO.
Read MoreGrand Rounds Recap 01.27.2021
/This week Dr. Hughes took us through the months Morbidity and Mortality cases. Dr. Shaw taught us what he has learned from the television show Scrubs. We learned about nausea and vomiting in pregnancy from Dr. Ferreri and ended the day with a minor care themed R3 small groups.
Read MoreGrand Rounds Recap 1.29.20
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This week we had another great M&M where Dr. Klaszky covered exciting topics such as refractory V fib, hypothermia and cerebral malaria. We learned about misnomers, mimics and lies about TB from Dr. Owens. Dr. Zalesky skillfully walked us through a simplified approach to reading brain MRIs. Lastly, Dr. Leech and Dr. Goel faced off in a CPC involving a patient with ALS.
Read MoreGrand Rounds Recap 9.4.19
/This week in grand rounds we discussed all types of critically ill patients, first covering the spectrums of hypothermia and shock. We then had a fascinating case follow up on a patient who developed torsades des pointes, and learned how to perform the HINTS exam and incorporate it into our practice. We then discussed pediatric osteomyelitis and it’s subtle presentation, and finally covered musculoskeletal ultrasound of the shoulder, knee, and ankle.
Read MoreGrand Rounds Recap 6.26.19
/This week was the last grand rounds of the academic year. We started off with the monthly Morbidity and Mortality conference led by Dr. Colmer. This was followed up by a CPC on Infectious Mononucleosis from Dr. Jensen and Dr. Stolz. Dr. Urbanowicz then discussed if there is a use of platelet function studies in the Emergency Department. The day ended with Dr. Murphy-Crews describing a fascinating case of severe hypothermia and outlining the interventions available to us in the ED for these patients. See you next week!
Read MoreGrand Rounds Recap 3.14.18
/This week's Grand Rounds opened with Dr. Curry discussing the paucity of literature on double defibrillation in VF. Dr. Mand then led small group discussions about the clinical utility of the pelvic xray. This was followed by Dr. Kreitzer expertly identifying incomplete Brown-Sequard Syndrome in Dr. Banning's CPC. Dr. Liebman discussed an interesting presentation of meningitis in a pediatric patient. Finally, our PEM colleagues led case based presentations of pediatric DKA, cat scratch disease, and a simulation featuring a patient in hypothermic cardiac arrest.
Read MoreGrand Rounds Recap 4.19.2017
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This week kicked off with a Tox filled R4 Simulation where we learned about ASA, digoxin, and hydrofluoric acid toxicities. This was followed by lectures on cardiac disease in diabetes, pediatric pain management strategies, physician burnout and hypothermic cardiac arrest.
Read MoreGrand Rounds Recap 8/10
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This week, Dr. Palmer updated us on operations within the department, and dropped some stroke knowledge with his case follow up of altered mental status in a sickle cell patient. Drs. Scupp and Merriam presented cases on pediatric headache and hypothermia, respectively. Dr. Fananapazir tackled etiologies of fever including UTI and Kawasaki in our combined EM/PEDS lecture. We were honored to receive guest speaker Dr. Catherine Marco from Wright State University, who is senior member of the executive committee of ABEM and lectured on ethical issues of resuscitation.
Read MoreGrand Rounds Recap 12/30/15
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Morbidity and Mortality Conference with Dr. LaFollette
Tracheoinnominate Fistula
One of the most dreaded days in the ED, a post-trach patient presents with a small bleed that stopped, is this one of 50% of patients with a TI fistula waiting to unleash?
- 0.3% occurrence after routine tracheotomy
- Incidence peaks 7-14 days after procedure
Once the patient starts massively bleeding - what's your next move hotshot?
Grand Rounds Recap 10/7
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Evidence Based Medicine on Tachydysrhythmias with Drs. Ludmer and Miller
- SVT is an umbrella term that includes AVNRT, atrial fibrillation and flutter, and polymorphic multifocal atrial tachycardia (MAT)
- AVNRT (AV Node Re-entrant Tachycardia) is the correct term for what is commonly diagnosed as SVT,
- MAT usually occurs in critically ill elderly patients with respiratory failure and is a poor prognostic sign, associated with 60% in hospital mortality. Treatment is to treat the causative pathology.
- REVERT Trial: Modified valsalva vs standard valsalva performed in 10 EDs with 428 patients in England. Findings included a 17% conversion with standard methods and 43% with the modified valsalva.
Flights - A Stab in the Dark - Curated Comments and Expert Commentary
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Thanks to everybody who contributed to an excellent discussion of the care of the patient on our second “flight.” If you didn’t get a chance to check out the case and the discussion, check it out here. Below is the curated comments from the community and a podcast from Dr. Hinckley and Flight Nurse Practitioner Jason Peng
Q1 - Walk through your initial assessment of this patient. What are the critical aspects of the assessment of this patient?
In response to this question, most everybody wanted to first act on the bleeding wound in the patient’s right antecubital fossa. As explained by Dr. Renne, “I would want to be systematic but efficient, probably using a C-ABCD approach to these kind of critical patients, with the first C being any sort of life-threatening but "C"ontrollable hemorrhage.” Dr. Renne also had a fine point with regards to checking for other potential, as of yet unseen, injuries. This is a patient with multiple stab wounds, it is crucial to conduct a quick, but thorough search for stab wounds to the back, axilla, groin, and/or other locations where significant blood loss could be caused by a stab wound.
Read MoreGrand Rounds Recap - 1/21/15
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Evidence-Based Emergency Medicine: Accidental Hypothermia with Drs. Mudd & Riddle
Grading the Severity of Hypothermia
- Mild hypothermia is defined as 32-35 °C and symptoms include confusion and diuresis
- Moderate hypothermia occurs from 28-31°C and is associated with lack of shivering, atrial arrhythmias, and worsening changes in mental status (including paradoxical undressing)
- Severe hypothermia happens when core body temperature is less then 28 °C and is associated with coma, significant decreases in metabolism, and a very low threshold for V-fib
