Grand Rounds Recap 1.3.17

Grand Rounds Recap 1.3.17

The first grand rounds of 2018 started out with an R4 Simulation that highlighted the clinical presentation, diagnosis, and management of salicylate toxicity.  This was followed by a guest lecture by Dr. Richard Sears, who discussed the benefits of wellness and mindfulness, and how we can apply them in the workplace.  Dr. Hall then went over the utility and application of various labs used to evaluate patients with sickle cell disease who present in vaso-occlusive crisis.  We then finished the conference with a case based discussion on septic bursitis led by Dr. Mike Klaszky. 

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Grand Rounds Recap 12.20.17

Grand Rounds Recap 12.20.17

The final Grand Rounds of 2017 opened with Morbidity and Mortality led by Dr. Kari Gorder. Drs. Liebman, Banning, and Owens then shared exciting Global Health cases from their travels to Tanzania and Guatemala. Dr. Grace Lagasse gave her soapbox lecture on firearm violence and the Emergency Department. Finally, our dentistry colleagues Drs. McMahon and Dagher refreshed our techniques and skills in the management of dental trauma.

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Grand Rounds Recap 12.13.17

Grand Rounds Recap 12.13.17

In the penultimate Grand Rounds of 2017 Drs. Klaszky and Spigner gave us an in-depth look of the evidence behind treatment of asthma in the ED and walked up through their new QI/KT pathway. Dr. Summers provided a great review of the resuscitation of the burn victim. We closed things out with our quarterly PEM-EM combined simulation sessions which included cases of children with difficulty breathing, seizure and stridor. 

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Grand Rounds Recap 12.6.17

Grand Rounds Recap 12.6.17

We had a jam packed Grand Rounds this week kicked off by Dr. Carleton's airway lecture discussing tools to maximize fiberoptic intubation success. Next Drs. Roche and Plash led us through wilderness medicine small groups discussing plant ingestions and creative extrication techniques. Drs. Murphy-Crews and Bryant participated in a CPC case with a seizing neonate followed by Dr. O'Brien's discussion of blunt neck trauma. Next Dr. Cotton presented data on physician burnout and how to combat it while Dr. Li wrapped things up with an overview of Kawasaki's disease. 

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Grand Rounds Recap 11.29.17

Grand Rounds Recap 11.29.17

This week Dr. Lagasse gave us a great M&M covering intra-ocular foreign bodies, empyema management in the ED and septic cardiomyopathy. Dr. Iparraguirre lead small groups in EKG case studies in heart blocks, followed by Drs Nagle and LaFollette squaring off in a CPC of an undifferentiated patient with aphasia. Drs Goel and McKee wrapped up this week with a clinical soapbox on patient turnover and a case follow up of lytics in massive PE.

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Grand Rounds Recap 11.8.17

Grand Rounds Recap 11.8.17

This week, we started things off with a great Quarterly Sim led by our faculty. The oral boards cases, led by Drs Stettler and Roche, involved an acute presentation of holiday heart, a post-partum patient with flash pulmonary edema, and a very questionable spider bite. The simulation, led by Drs Fernandez, Hill and Stolz, focused on two patients that were in shock: one due to a ruptured ectopic pregnancy and one due to a pericardial tamponade. We then moved on to the pediatric side of things, where Dr. Gleimer discussed neonatal rashes, and we took a look at pediatric syncope with Dr. Fananapazir. 

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Grand Rounds 10.25.17

Grand Rounds 10.25.17

Dr. Ludmer kicked things off with this month's Morbidity & Mortality conference where we discussed C. Diff, spinal cord compression, LP in the setting of anticoagulation and cardiac arrest with an LVAD. Dr. Stettler led the next segment of our longitudinal leadership curriculum with a look at the mentor/mentee relationship. We finished up with a soapbox lecture by Dr. Titone on conflict resolution and an R3 follow up by Dr. Bernardoni who discussed the crashing patient with right ventricular failure and pulmonary arterial hypertension. 

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Grand Rounds Summary 10.18.17

Grand Rounds Summary 10.18.17

This week Dr. Gottula gave us a great in-depth explanation into alloimmunization and the use of RhoGAM in the ED. Dr. Owens and Faryar participated in a CPC centered around a sickle cell patient with knee pain. Dr. Asghar from orthopedics discussed the management of spine fractures in the ED. Our visiting professor Dr. Gail D'Onofrio discussed the ongoing opioid abuse issues facing the country. Dr. Hall discussed industrial injuries while Dr. Polsinelli wrapped things up with a discussion about how to use EMR to report core measures. 

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Rh-D Alloimmunization Prevention in the Emergency Department

Rh-D Alloimmunization Prevention in the Emergency Department

The risk of alloimmunization in pregnancy is one the EP faces every day, but what are we preventing? when do we need to consider increasing our RhoGAM dosing? and do you really need a type and screen for the same patient in the same pregnancy? Dr. Gottula gets to the bottom of the type and screen and presents a rational algorithm for working up the Rh status of the pregnant patient in the ED.

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Grand Rounds Summary 10.11.17

Grand Rounds Summary 10.11.17

Dr. Stolz started Grand Rounds off with a great talk on lung ultrasound. Our consultant of the month, Dr. Hebbeler-Clark, gave a talk on patient safety and swarms. Dr. Lipshaw, a Peds-EM fellow, discussed the differential, evaluation, and management of congenital heart disease babies in the Emergency Department. Finally, Dr. Teuber ended with an interesting discussion on priapism. 

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Grand Rounds Summary 10.4.17

Grand Rounds Summary 10.4.17

This week Drs. Jarrell and Nagel kicked off Grand Rounds with their evidence based review of the hypertension management in the ED. Drs. Gorder, Lagasse, O'Brien, and Polsinelli discussed the difficult management of the patient in both cardiogenic and septic shock, reviewed heart murmurs, and endocarditis. Dr. Bryant made us squirm with her Global Health quick hit case review of parasitology, Dr. Lane led a great group discussion about the utility of procalcitonin in adults, and Drs. Habib and Roche ended Grand Rounds with a great CPC case!

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Pro's and Con's of Procalcitonin

Pro's and Con's of Procalcitonin

Procalcitonin was reviewed on Taming the SRU in the context of other biomarkers (ESR, CRP) last year with a grand rounds discussion of its utility in the setting of a febrile 7 week old. As procalcitonin has continued to gain traction in the world of pediatric EM – receiving evaluation as part of proposed protocols for management of febrile infants (1) and for its utility as an aid to diagnosis of Serious Bacterial Infection (2,3) – we turned our attention this year to procalcitonin’s use in adults. Procalcitonin testing has been studied and available for decades (as St. Emlyn’s noted in an update earlier this year), but has not really established itself in widespread use in adults (as EMDocs noted in a sepsis update in 2014). In this blog post, we take the approach of going back to what is known (and is NOT known) about the biochemical basics of this molecule to give context to the sometimes confusing smorgasbord of proposed applications for procalcitonin testing that exists in the literature.

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Grand Rounds Summary 9.27.17

Grand Rounds Summary 9.27.17

Dr. Titone held a great in-depth M&M this month with cases from tuberculosis to typhilitis (which is a thing). Drs. Baez and Goel took us through cases of coding Torsades and coding Pine Sol ingestions, followed by Dr. Skrobut who delicately closed the day with a discussion of testicular complaints in the ED.

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