Grand Rounds Recap 8.16.23

Grand Rounds Recap 8.16.23

Join us to summarize another fantastic series of Grand Rounds lectures. We start off with in-flight emergencies, including changes to physiology and what equipment is available to you on most commercial flights, with Dr. Urbanowicz. Followed by a literature-filled debate between Drs. Lane and McDonough on the utility of CT pan-scans in trauma patients. With the help of Dr. Shewakramani, we all learn how to better recognize and care for patients with sepsis. Meanwhile, Dr. Roche teaches us about all various bites/stings- including marine species, scorpions, and mosquitos! Lastly, Dr. Wright introduces us to the science of reliability and how to design processes in healthcare to be more reliable, with the ultimate goal of improving our care of patients.

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The CLOVERS Trial

The CLOVERS Trial

Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. One of the primary pathophysiologic mechanisms involves complex cascade of host dysregulation in response to an infectious stimulus (Evans, Rhodes et al. 2021, Jarczak, Kluge et al. 2021). Recent meta-analyses and systematic reviews evaluating mortality in patients with septic shock reported mortality as high as 35% and 38% at 30 and 90 days, respectively (Vincent, Jones et al. 2019, Bauer, Gerlach et al. 2020). Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. 2022), ideally with antibiotics administered within one hour of sepsis recognition by the treating provider (Evans, Rhodes et al. 2021). Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al. 2022).

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Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

Early 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.

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Grand Rounds Recap 2.1.23

Grand Rounds Recap 2.1.23

This week in Grand rounds, we had some case reflection from R4 Dr.Zalesky reminding us to avoid anchoring, be aware of our biases for or against patients, and avoid creating a rude work environment. Dr. Moulds and Dr. Goel had a CPC showdown with a case of Cecal Diverticulitis, while Dr. Artiga gave us the low down on Lung Ultrasound in the ED. We wrapped up the day with an R4 lead simulation on a case of Thyrotoxicosis.

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Grand Rounds Recap 9.28.22

Grand Rounds Recap 9.28.22

This week we had a tour de force of education goodness. We started off with Dr. Mullen presenting Morbidity and Mortality Conference. This was followed with an updated DKA QI/KT protocol developed by Dr. Shaw and Dr. Glenn. More great faculty Core Content was brought by Dr. Irankunda elucidating high pressure injection injuries. We wrapped up the day with some research nuggets with Dr. Freiermuth.

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Grand Rounds Recap 2.2.22

Grand Rounds Recap 2.2.22

In this week’s Grand Rounds, Dr. Laurence led us through an incredible and education Morbidity and Mortality Conference, Drs. Gillespie and Continenza worked through a dramatic case combining vision changes and rash, Dr. Wright reminded us to not forget the esophagus in our patients with chest pain and Dr. Connelly gave a fantastic overview of EMS provider education and systems structure in her R4 Capstone. Finally, our incredible visiting professor, Dr. Megan Rybarcyzk gave us insight into building an emergency medicine education program in the midst of a pandemic and provides tips and tricks for those seeking a career in global health.

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Grand Rounds Recap 10.6.21

Grand Rounds Recap 10.6.21

This week Dr. Laurence provides great case-based learning in our monthly morbidity and mortality conference, Dr. Roblee walks us through aortic dissection management, Drs. Kletsel and Ferreri evaluate fluid resuscitation of ESRD patients, and Dr. Davis covers fungal skin infections.

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Grand Rounds Recap 04.28.21

Grand Rounds Recap 04.28.21

We had a fantastic Grand Rounds this week!! Dr. Li kicked us off with our monthly Morbidity and Mortality conference, covering cases ranging from methamphetamine intoxication to the evidence behind the medical pan scan. Dr. Harty then led us through several cases where ultrasound made critical diagnoses that completely altered patients’ clinical courses #SonoWavesFTW. Dr. Modi passionately educated us on the importance of an individual’s name, in both identity and cultural significance, and how crucial it is to respect and pronounce names correctly. Lastly. Drs. Berger, Irankunda, and Urbanowicz expertly discussed pediatric orthopedic injuries.

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Grand Rounds Recap 05.27.20

Grand Rounds Recap 05.27.20

This week Dr. Klaszky presented cases to help us improve our clinical care in the ED with our monthly Morbidity and Mortality conference. Drs. Hall, Modi, and Shaw taught us about marine, reptile, and arthropod envenomations with their R3 small group session. Finally, we were honored to (remotely) host the nationally renowned Dr. Megan Ranney, who gave us an eye-opening presentation on the overlap between gun violence, public health, and the role of emergency medicine.

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Grand Rounds Recap 03.25.20

Grand Rounds Recap 03.25.20

In our first ever teleconferenced Grand Rounds - this week Dr. Kathryn Banning presented us with opportunities to improve the care we deliver in our monthly morbidity and mortality conference. Then, our panel of expert clinicians and self-aware humans engaged us all in a discussion of wellness and longevity that was at times vulnerable and candid, but also enlightening from start to finish. Finally, we learned more about radio operations and reflected on both failures and victories in HEMS CQI cases with our Air Care leadership team.

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Air Care / B Pod Series: Intravenous Fluid Resuscitation

Air Care / B Pod Series: Intravenous Fluid Resuscitation

Normal saline has taken hold as the de facto resuscitative fluid in the majority of health care institutions in the developed world. Walk through the recent data with Dr. Christopher Shaw which suggests that balanced fluids may provide benefit to patients suffering from a wide array of critical illnesses.

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Grand Rounds Recap 1.15.20

Grand Rounds Recap 1.15.20

We had another great week in Grand Rounds, starting with a QI/KT presentation from Drs. Hunt and Pulvino about Tumor Lysis Syndrome. Next, Dr. Meigh gave a great presentation about TORCH infections and Dr. Spigner gave his R4 Capstone lecture on pre-hospital sepsis care. We welcomed a guest speaker, Dr. Henning, from podiatry who discussed a number podiatry emergencies. Finally, the week wrapped up with a simulation of an inferior STEMI in trauma.

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Grand Rounds Recap 11.20.19

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 10.16.19

Grand Rounds Recap 10.16.19

This week we disccused interventions for the crashing asthma patient with Dr. Mand, ESRD and dialysis related complications with Dr. Scanlon, shoulder and elbow xrays with Drs. Crawford and Scanlon, and a case of intussusception in an adult patient with Drs. Hunt and Bryant. Dr. Gauger provided his case follow up on PJP pneumonia complicated by methemoglobinemia, and Dr. Li took us through the ins-and-outs of gastric lavage in a simulated case of calcium channel blocker overdose.

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Sepsis Journal Club Roundup

Sepsis Journal Club Roundup

The management of patients with sepsis can be exceptionally complex. As with many patient’s with complex critical illnesses, often times attention to seemingly minor aspects of the patient’s management can have significant impacts on the patient’s course of illness. In this recap of our most recent journal club, we review 3 such aspects of the care of patients with sepsis. Does the type of IV fluids really make a difference? Are steroids a friend or foe in the care of these patients? And can the simple bedside assessment of capillary refill replace serial measurements of lactate?

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