Grand Rounds Summary 9.20.17

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Grand Rounds Summary 9.20.17

This week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls.  This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate.  Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula.  Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine.  Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.

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The Future of Airway Management?

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The Future of Airway Management?

What is the future of airway management in the ED?  How can we make our practice more effective and more efficient?  In this journal club recap, we focus on 2 topics emerging in the literature - flush rate O2 for pre-oxygenation and head of bed elevation during intubation.

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

Since the turn of the century, lactate has become a mainstay in emergency medicine and critical care laboratories. Some clinicians may hate it, others may love it, but very few can feign apathy on the subject. The utility of lactate in the emergency department and the ICU in guiding resuscitations, predicting mortality, or identifying occult critical illness continues to be discussed in the literature, most fervently in the realm of sepsis. But what are the humble beginnings of this molecule? Most fundamentally, how is lactate generated in the setting of critical illness? And how did it come to be so firmly embedded in our understanding of the pathophysiology of critically ill patients?

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Grand Rounds Summary 9.13.17

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Grand Rounds Summary 9.13.17

'Twas a fantastic grand rounds.  Drs. Banning and Golden started it off taking us through the most recent evidence for management of sub-massive and massive PE, as well as presenting their algorithm to be published on Emergency KT.  This was followed by a global health lecture given by Dr. Lagasse, which covered a range of re-emerging infectious diseases.  Next, Dr. Bryant took us through multiple pediatric cases, and discussed her approach in determining whether to discharge, transfer, or treat pediatric patients with common / representative complaints.  Dr. Adeoye then took us through the history and development of our current approach to the management of acute ischemic stroke.  Dr. LaFollette then took us through an evidence based approach to removing things from where they shouldn't be in his edition of mastering minor care, discussing approaches to removing retained objects from ears and skin.  We then finished the conference with two interesting cases:  One presented by Dr. Sabedra that was followed by a discussion on the diagnosis and management of massive hemoptysis, and the other presented by Dr. Dang illustrating the differences and similarities hyperthermic toxidromes including NMS and serotonin syndrome as well as their management.  

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Grand Rounds Summary 9.6.17

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Grand Rounds Summary 9.6.17

Dr. 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.

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Soft Tissue Neck Radiographs - Are They Useful?

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Soft Tissue Neck Radiographs - Are They Useful?

In March 2015, Dr. Renne did a Grand Rounds lecture on soft tissue neck radiographs, which offers a great review of normal anatomy and systematic approach to reading films (“CHESS”). Yet, in my small, informal (not scientific at all) poll of some of our residents, none had ever ordered a soft tissue neck film. Are soft tissue neck radiographs useful? You be the judge. 

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Grand Rounds Recap 8.30.2017

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Grand Rounds Recap 8.30.2017

This 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.

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Troublesome Tracheostomies

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Troublesome Tracheostomies

Troubles with tracheostomy tubes can be some of the most anxiety provoking complaints we see in the Emergency Department.  Airway master and Dr. IC Cordes himself, Dr. Steven Carleton, MD PhD joined me on the podcast to help demystify 2 common tracheostomy related complaints - the bleeding trach site and the displaced tracheostomy tube.

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Grand Rounds Recap 8.23.17

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Grand Rounds Recap 8.23.17

Dr. Carleton started things off with a review of oral fiberoptic intubation and a step by step guide to trach recanalization. Next we headed off to EM-Neuro combined conference where Dr. Neel discussed headaches that kill, headaches that maim and headaches that annoy. Dr. Thompson walked us through a case of vertebral artery dissection and Dr. Liebman kicked off our wellness curriculum. Dr. Roche finished things up with a discussion the nuances of toxicology in the community. 

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The Radioactive Heart

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The Radioactive Heart

For Journal Club this past week we covered what is undoubtably one of the more controversial diagnostic tests used in the evaluation of patients presenting to physicians with chest pain.  The most recent NICE guidelines recommend Coronary CT as the first line test for patients with stable angina symptoms but don't Coronary CT's lead to increased downstream testing? more radiation exposure? To investigate this topic we took a look at 3 articles focused on the utility of Coronary CT scans. Take a listen to the podcast and read the recap to learn for yourself.

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Grand Rounds Recap 8.9.17

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Grand Rounds Recap 8.9.17

This week's Grand Rounds began with Quarterly Sim led by Dr. LaFollette who walked us through a case of cardiogenic shock and neutropenic fever. Dr. Curry led us through an oral boards triple case with an unstable MCC, a FB ingestion and perforated viscous. Dr. Hill presented an eOrals case of thyroid storm. Lastly was PEM-EM combined conference, led by Dr. Wurster Ovalle, which focused on the treatment of pediatric DKA with a special focus on cerebral edema. 

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Grand Rounds Recap 8.2.17

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Grand Rounds Recap 8.2.17

This week was filled with lots of high yield quick hit Grand Rounds sessions. Dr. Stolz kicked it off with her first official lecture as UC EM's Ultrasound Director with a talk on how to use ultrasound in resuscitation of the shock patient. Next Dr. Knight went over some procedural complications and then switched gears to pearls on how to give a stellar lecture. Dr. Lagasse walked us through a case of ascending cholangitis followed by Drs. Colmer, Soria and Continenza who led small groups focused on care of the geriatric patient. Dr. Toth followed with management of eye complaints in the community and Dr. Shaw wrapped things up with an update on the opioid epidemic in Ohio.

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