End-Tidal CO2 monitoring has a variety of uses in the Emergency Department. Whether used diagnostically or for monitoring of a patient’s physiology, clinicians must possess an understanding of the information that you can gather from EtCO2 waveform tracings. Knowing how to interpret the waveforms makes EtCO2 much more than a number, allowing the clinician to gain insight into minute to minute changes in a patients physiological state.
Read MoreEarly recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.
Read MoreThe diagnostic ability of undifferentiated hypotension by the Emergency Physician has increased exponentially with the RUSH examination. Join Dr. Frederick as she searches and finds the source of hypotension in an elderly female in December’s Ultrasound Case of the Month
Read MoreElectruction is a significant cause of morbidity and mortality with a widely variable injury pattern. Join the Air Care Series and Annals of B Pod teams as we dive into the pathophysiology and literature surrounding electrocution.
Read MoreEffective efficiency. Zoonotic viruses including Powassan and Nipah. FOAMed in practice. Symptomatic bradycardia in adults. Rapid fire ultrasound literature review. Cardiogenic shock.
This week’s Grand Rounds had something for everyone! Check out the summary.
Read MoreWe are all familiar with the “lethal triad” of trauma – coagulopathy, hypothermia, and acidosis. We have multiple methods wherein we attempt to prevent or reverse these physiologic derangements. In particular, in recent years many teams have focused heavily on limited crystalloid infusions, increasing our early blood product transfusion (especially plasma), and early administration of tranexamic acid.
One of the main reasons we focus on these interventions is to address trauma-induced coagulopathy. Trauma-induced coagulopathy has a multifactorial etiology and is contributed to by the other corners of the triad (hypothermia and acidosis). However, one of the least appreciated contributing factors are electrolyte deficiencies, in particular calcium.
Read MoreThis week Dr. Klaszky started us off with a great M&M of reviewing tPA and sumitriptan indications, EMTALA background and more. Dr. Chuko led a small group discussion of syncope rules based on his post from earlier in the week, Dr. Roblee tried to stump a faculty during her CPC of a syphilis case. Check it all out in this week’s GR Recap!
Read MoreThis 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 MoreCardiogenic shock presents many challenges in both the transport environment and hospital setting. We aim to review the current state of evidence pertaining to the medical management in the critical care transport environment.
Read MoreYou’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 MoreThis week's Grand Rounds started off with our monthly Morbidity and Mortality conference with Dr. Titone. This was followed by a lecture on pediatric bloody diarrhea with Dr. Shan Modi. Dr. Claire O'Brien then gave her Clinical Soap Box lecture on cost and waste within the healthcare system. Dr. Kreitzer then gave an evidence based lecture on current research in sepsis and refractory septic shock, followed by our consultant of the month lecture with Dr. Anthony Blanchard from podiatry discussing foot wounds and osteomyelitis.
Read MoreThis week's Grand Rounds started out with another installment of our leadership curriculum led by Dr. Stettler, where we discussed how to identify and manage finance in leadership. This was then followed by Dr. Makinen's small group session on thyroid diagnostics in the ED. Drs. Gauger and Loftus then went head-to-head on a case of syncope, found to have a massive PE. Dr. Miller then gave a great summary of current thoughts and future approaches to sepsis, followed by Dr. Murphy discussing post-ENT procedure bleeds in the ED. Dr. Curry then finished off the conference with his "Mastering Minor Care" segment on epistaxis.
Read MoreThis week Dr. Gorder led us off with August's M&M cases, followed by Dr. Betz giving us great in-depth example of a proper joint exam from the perspective of sports medicine. Dr. Makinen gave us a talk of accidental hypothermia, Dr. Ludmer examined the link between chronic pain and depression and how concurrent treatment can help our patients quality of life. Dr. Wright gave us an update on UCEM Global Health and Dr. Colmer gave us a look into the critical care management of a DKA case.
Read MoreThis week we'll be recapping the discussion of our most recent journal club where Dr. Christian Renne, Dr. Anita Goel, and Dr. Maika Dang led us in a discussion centering on the use of vasopressin both in sepsis and in vasoplegic shock states. Take a listen to the podcast below and read the brief summaries of their articles to boost your understanding of Vasopressin. Should you reach for it first or is it a second class pressor?
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.
