emergency medicine tamed
Taming the SRU. The SRU is the "Shock Resuscitation Unit." It is a crucible of clinical training for the residents of the University of Cincinnati Emergency Medicine Residency training program.
This week’s grand rounds features an overview of crush injuries with Dr. Della Porta, a fantastic look into the evidence behind preeclampsia and eclampsia management with Drs. Brower and Jackson, a discussion of evidence behind emergency medicine pharmacology dogma with Dr. Nagle, and a discussion of the cost of healthcare with Dr. Thompson.
Read MoreWe had an exciting Grand Rounds this week. We started off with our visiting lecturer, Dr. Jennifer Wiler, who gave us an excellent overview of the dollars and cents behind the care that we provide in the emergency department. Afterwards we practice some oral board style cases. Dr. Betz led a challenging triple patient encounter where we had to simultaneously manage a knee dislocation, aortic dissection with involvement of the right coronary artery, and pneumonia in the setting of HIV. Dr. Curry led a riveting case of preeclampsia where identifying the critical history of a recent delivery was critical to initiating the correct management. We wrapped up the day with a simulation led by Drs. Hill, LaFollette, and Lang on in-flight emergencies!
Read MoreFrom an incidental notice of an elevated pressure to fulminant pulmonary edema and seizures, the spectrum of hypertension in pregnancy is broad and Dr. Roblee is here to break it into an easy diagnostic path.
Read MoreThis week, we started things off with a great Quarterly Sim led by our faculty. The oral boards cases, led by Drs Stettler and Roche, involved an acute presentation of holiday heart, a post-partum patient with flash pulmonary edema, and a very questionable spider bite. The simulation, led by Drs Fernandez, Hill and Stolz, focused on two patients that were in shock: one due to a ruptured ectopic pregnancy and one due to a pericardial tamponade. We then moved on to the pediatric side of things, where Dr. Gleimer discussed neonatal rashes, and we took a look at pediatric syncope with Dr. Fananapazir.
Read MoreDr. McKinney from our MFM service started us off with some pearls of 2nd and 3rd trimester complications and management. Drs Murphy, Liebman, McKee and Whitford taught small groups about tips and tricks of extensor tendon repair, hip ultrasound and compartment pressures. Dr. Hughes gave us a talk on plain film utility in the ED and finally Drs. Scanlon and Doerning faced off in a CPC of a case of HELLP syndrome.
Read MoreThis week, Dr. Carleton talks logistics, tips and tricks of lower extremity regional anesthesia. We had a sim on the challenges of afib control in the hypotensive patient, reviewed rare trauma populations in oral boards and Dr Richardson discussed hospice and palliative care in the ED.
Read MoreAnother month, another M&M, where this month we learned despite a great clinical rationale, there will always be cases that are a wolf in sheep's clothing. Also be sure to check out a review of chest CT indications in pregnancy, pregnancy-induced hypertension, lactate utilization in the ED and a basics course of ECMO - coming soon to an ED near you...
Read MoreThe patient is a multiparous female in her 20s, post-operative day 8 from an uncomplicated repeat low transverse cesarean section at 39 weeks gestation after an uncomplicated pregnancy, who presents with SOB. She was discharged home on post-operative day 2 with a healthy female infant. She returns today with complaints of shortness of breath for 3 days and swelling in her bilateral lower extremities for 6 days. Over the same time course she endorses orthopnea, paroxysmal nocturnal dyspnea, weight gain, and chest pain. She describes the chest pain as substernal and intermittent. She also feels as if her chest is making a crackling noise when she exhales. She denies fevers, cough, nausea, vomiting, headache, or abdominal pain. She reports that her incision is healing well. She denies pain or drainage from the incision. She is breast-feeding her daughter, who is doing well at home. She has not yet seen her Obstetrician in follow-up but did receive all appropriate prenatal care.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
