This week we had a special visit from Dr. Darren Braude from the University of New Mexico Department of Emergency Medicine to speak on special topics in airway management. He introduced us to the idea of Rapid Sequence Airway (RSA) and other novel thoughts on extraglottic devices. We then had a chance to dive in to our regularly scheduled program with topics ranging from tuberculosis to ED operations to complex febrile seizure. Enjoy!
Read MoreIn the Emergency Department, we frequently encounter patient's with facial fractures and associated lacerations. The orthopedic surgery literature strongly supports the use of antibiotics for open fractures. The facial surgery literature, however, does not have extensive publications addressing the use of antibiotics in open facial fractures. So what are we to do? Does every fracture get antibiotics? If not, which fractures?
Read MoreThis week we learned about risk stratification for PE and how to work it up in special populations. We covered neonatal resuscitation and pediatric hematologic emergencies. We got a crash course in the returning traveler with fever. We reviewed current guidelines for treatment of sexually transmitted infections.
Read MoreHand and wrist radiographs are some of the most common and most challenging x-rays to read. Take 10 minutes to watch a video and freshen up on both the anatomy and technical factors associated with wrist radiographs.
Read MoreBurns, bubbling airways and bradycardic arrests: all part of this week's grand rounds that brought plenty of knowledge our way. This week we heard from Dr. Dale, burn surgeon, about the latest in burn management. Dr. Carleton ran through some of his hardest airway cases for an infallable mental model of intubation. Our R3s gave a practical session on transvenous pacer placement and Dr Kircher gave us his clinical soapbox of pneumonia management.
Read MoreThis week's Grand Rounds included M&M where we learned all about bleeding and how to stop it, listened to a Case Follow-up about the Neurological Complications of Infective Endocarditis, and had lectures on BRUE, Hand Injury management in the community, and Impostor Phenomenon.
Read MoreNSAIDs are excellent analgesics that can decrease the use of opiatess for pain, but might lead to poor healing from orthopedic injuries.
In vitro studies and rat models since the early 80s showed delayed fracture healing with NSAIDs, and the effects appeared to be dose-related. These findings have been re-demonstrated in future in vitro and rat studies as well. In humans however, the data has been, to say the least, mixed...
Read MoreThis week included our first every chalk-talk about antibiotics focusing on beta-lactams. We had our quarterly AirCare grand rounds where we learned about some special tools we carry on the aircraft including point of care lab testing and specialized suction devices. We also did a high fidelity hemorrhagic shock simulation. In two case follow-ups we learned about some special considerations in ACS and for pregnant patients in trauma. Read on!
Read More“Reason itself is fallible, and this fallibility must find a place in our logic.” - Nicola Abbagnano
Decision making in Emergency Medicine is intensely complex and it also the defining characteristic of the practice of Emergency Medicine. To outside eyes we may seem to be a specialty of action: chest tubes, intubations, heroic resuscitations with massive amounts of blood products and IV infusions. In truth none of the “action” of our specialty, the big sexy things they make into TV shows and movies, occurs without rapid, precise, and accurate thinking and decision making. But the Emergency Department can be a hostile environment to the decision making process. And, I’m not just talking about the noisy environment, the multiple interruptions, the patients with a wide variety of chief complaints and acuity seen in quick succession. There’s seemingly a thousand different hurdles between the instant a patient recognizes that something might be wrong with them and the moment a clinician diagnoses the problem.
Read MoreThis 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 MoreThis week we spent some time with in-situ trauma simulations, followed up by lectures on medical causes of trauma with Dr. Thompson, STEMI and aspirin allergy with Dr. Axelson and a cardiology update with our specialist of the month from our cardiology intensivity and interventionalist Dr. Tim Smith.
Read MoreThis week in Grand Rounds we reviewed the morbidity and mortality cases from June and learned about infective endocarditis, intimate partner violence, tracheal injuries, pituitary adenomas, hepatic encephalopathy, epistaxis, and carfentanil - a new and dangerous adulterant in heroin. Dr. Denney was challenged to a case of dural venous sinus thrombosis. We learned about the life of an Air Force Reserve physician with Dr. Powell. Dr. Derks taught us about negative pressure pulmonary edema. Finally, we asked the question #whatsyourquestion? and reviewed how to call a good consult. Read on!
Read MoreThis week Dr. Knight taught us about the management of seizures and about how to manage our own fear. We were schooled on the hypotensive LVAD patient by Drs. Boyer, DeVries and Winders. We learned about oncologic emergencies from Dr. Continenza. Dr. Gorder tamed the SRU and taught us about chemical asphyxiation and burn injuries in the process.
Read MoreThis week we got an operations update with some new markers of quality and new guidelines on HIV testing. We were reminded about patient literacy and the advantages of keeping it simple. Dr. Hill also taught that every shift our biases and decision making do affect patient care, it is our duty to recognize and use them to our patients' advantage.
Read MoreCase #1: 28 yo M who was poked in the eye while wrestling. Small periorbital ecchymosis, conjunctival erythema, reactive pupils, consensual photophobia, fluorescein negative. Normal IOP bilaterally.
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.
