This week we recap the latest IOM recommendations on cardiac arrest management, evidence-based update on anaphylaxis management, management of the morbidly obese code and discuss the ins and outs of immunosuppressive agents.
Read MoreThis the recap of the 2nd of our 2 "Sepsis Smackdown" cases. Several weeks back, we presented to you the case of Lucy, a 79 yo female resident of a nursing facility presenting to your busy community ED with reported altered mental status. She's unable to provide you with a meaningful history but you piece together she's been acting abnormally at the nursing facility over the course of the past several days at the nursing facility and is now febrile, tachycardic, and hypotensive. In your testing, you find her to have a UTI, begin her resuscitation and admit her to the hospitalist and MICU. While waiting for a bed, she continues to be poorly responsive to your resuscitation...
Read MoreBelow you will find the recap of the 1st case in our Sepsis Smackdown case series. Several weeks ago, we posed a clinical scenario followed by a series of questions. As a refresher the case was that of Linda, a 79 yo female resident of a local nursing facility who arrives to your busy community ED with altered mental status, hypothermia, tachycardia, hypotension, and along history of multiple complicated UTI's. You begin your work up and find her to again have a likely UTI with a urine dipstick with large leukocyte esterase, pH 5.5, 20 protein, negative nitrite.
Read MoreThis week in our summary we examine some critical pitfalls in sepsis care, the limping kiddo and the ever-reliable pulse oximetry in 5 hours of Grand Rounds...
Read MoreCase 1: Morbidly obese young female presents after overdose - tachycardic and unresponsive to sternal rub but maintaining saturations at 92% on a non-rebreather.
Difficulties in the morbidly obese and implications for airway management...
Use your rules for airway assessment
Both pulse oximetry and capnometry rely on the Beer-Lambert Law.
Acute Coronary Syndrome in Pregnancy
Epidemiology
Risk Factors
Many of these are typical ACS risk factors but are less prevalent in the pregnant population
Case 1: 45 yo male comes to the ED after being found down at the mall s/p defib x2 for a V fib arrest per EMS with a King Airway in place and undergoing active CPR. In the ED you achieve ROSC after defib x1 for Vfib and then PEA with multiple arounds of epinephrine. EKG shows inferior STEMI.
Case 2: EMS calls with advanced noticed for GI bleed presents tachycardic and hypotensive, actively bleeding with melanotic stool and hematemesis.
Read MoreThis is our first of 2 cases exploring the care of patients with sepsis in the Emergency Department. Similar to our "Out on a Limb" case series, the case presented is followed by a series of questions, with a discussion in the comment section facilitated by the post authors. In approximately 1 month (November 11th), the authors of the post will conduct a combined simulation/small group session reinforcing the learning points from the posts during Grand Rounds. Around this time, they will also curate the comments from the discussion and publish a post highlighting these learning points. Looking forward to a great discussion!
Read MoreThis is our first of 2 cases exploring the care of patients with sepsis in the Emergency Department. Similar to our "Out on a Limb" case series, the case presented is followed by a series of questions, with a discussion in the comment section facilitated by the post authors. In approximately 1 month (November 11th), the authors of the post will conduct a combined simulation/small group session reinforcing the learning points from the posts during Grand Rounds. Around this time, they will also curate the comments from the discussion and publish a post highlighting these learning points. Looking forward to a great discussion!
Read MoreYou have inherited a patient in the VA MICU at signout. The patient presented with spontaneous bacterial peritonitis and altered mental status and was intubated for airway protection and hypoxic/hypercarbic respiratory failure. The patient’s altered mental status has resolved but the patient remains intubated waiting for a second large-volume paracentesis that can’t be done over the long weekend at the VA. The RT calls you asking for a one time dose of 5mg Versed, but on a quick glance at the chart, the patient has been getting these Q2 hours for the last several days. You go to the bedside and find an agitated patient motioning to take out the tube. “He’s bucking the vent doc!”
Vent settings: AC-VC: TV500 RR12 PEEP8 FiO2 30%
Read MoreCases reviewed were from the month of August. We saw greater volume in 2015 than 2014 with longer ED hold times. We reviewed multiple cases including:
Acute Inflamatory Demyelinating Polyneuropathy
There are many risk factors for septic arthritis including age >80, Diabetes, Rheumatoid Arthritis, recent joint surgery, prosthesis, cellulitis. The absence of risk factors does not make septic arthritis less likely in an acute monoarticular arthritis
Monoarticular arthritis is often characterized as a warm, painful, swollen joint with limited range of motion. No studies to date have quantified specificity data on the physical exam. Therefore, clinicians must use their own clinical gestalt when interpreting physical exam findings.
Read MoreThere isn't a day that goes by in the ED that a patient does not get a chest x-ray. Whether the indication is chest pain, shortness of breath, cough, or line placement or intubation, interpreting chest radiographs is a critical, necessary skill for anyone working in the Emergency Department. Here you will find a brief video explaining how to interpret CXRs and 6 practice cases.
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.
