EKG Toxicology

/
EKG Toxicology

Emergency medicine physicians frequently assess and treat patients who have accidental or intentional poisonings. United States poison centers receive over two million case referrals per year. And, about 20% of these poisonings present to an Emergency Department for evaluation. Evaluation of these patients always includes a history and physical, but further testing can provide valuable information. Blood work is often be needed, but an EKG is a faster, cheaper tool that can provide key pieces of information prompting early interventions. 

Read More

Grand Rounds Recap 3.14.18

/
Grand Rounds Recap 3.14.18

This week's Grand Rounds opened with Dr. Curry discussing the paucity of literature on double defibrillation in VF. Dr. Mand then led small group discussions about the clinical utility of the pelvic xray. This was followed by Dr. Kreitzer expertly identifying incomplete Brown-Sequard Syndrome in Dr. Banning's CPC. Dr. Liebman discussed an interesting presentation of meningitis in a pediatric patient. Finally, our PEM colleagues led case based presentations of pediatric DKA, cat scratch disease, and a simulation featuring a patient in hypothermic cardiac arrest.  

Read More

Back to Basics: Pelvic XRays

/
Back to Basics: Pelvic XRays

Pelvic Xrays are a key component of trauma, fractures and dislocations seen every day in the ED, but when is the last time you went back over the anatomy and radiographic tips and tricks of the pelvic radiograph? Join Dr. Mand's thorough break down of this commonly used ED diagnostic - the Pelvic XR.

Read More

Grand Rounds Recap 3.7.18

/
Grand Rounds Recap 3.7.18

The first Grand Rounds of March opened with guest lecturer and UCEM alumni Dr. Matthew Valento discussing his career in toxicology as well as synthetic cannabinoids. Drs. Habib and Ham then discussed the evidence-based workup, management, and treatment of mammalian bites. Drs. Baez, Bernardoni, Randolph, and Shaw lead various small group sessions focused on high yield urological clinical knowledge, procedures, and trouble shooting techniques. Dr. Titone continued the midday genitourinary theme with her approach to the management of patients with indwelling urological drains and stents. Dr. Koehler ended the day with a discussion of high yield toxins.

Read More

Grand Rounds Recap 2.21.18

/
Grand Rounds Recap 2.21.18

This weeks grand rounds started off with our monthly Morbidity and Mortality with Dr. Lagasse.  We then discuss in Aircare grand rounds led by Drs. Dang and Renne the always harrowing complex patient transfers including LVAD, EKOS and more.

Read More

A Pain in the Neck

/
A Pain in the Neck

There are some areas in our practice where the literature grants us a somewhat sure path forward in the evaluation of our patients.  The decision whether or not to pursue cervical spine imaging studies following a traumatic mechanism of injury is one of these areas.  The NEXUS criteria and Canadian C-Spine Rule are useful guides for the evaluation of these patients.  What comes after the imaging can be a bit more challenging.  What do we do with patients who have persistent pain but negative imaging? To what extent do we pursue the possibility of a ligamentous injury? Must we wait for all patients to be sober so that we can "clinically clear" them in addition to our radiographic clearance.   The 3 articles below seek to answer some of these challenging questions.  Take a listen to the podcast and read the summaries to familiarize yourself with some of the latest literature addressing these challenging patient care scenarios.

Read More

Grand Rounds Recap 2.14.18

/
Grand Rounds Recap 2.14.18

This weeks Grand Rounds was started off with our guest lecturer, Dr. Esther Choo, who gave a compelling talk regarding gender disparities in medicine and the effects of gender bias in our profession and every day practice.  This was followed by Dr. Owens and Ventura giving their evidence based approach to the management of A-Fib, as well as previewing their upcoming algorithm for Tamingthesru.com.  Our pediatric EM colleague Dr. Valentino then walked us through current recommendations on the approach to the febrile infant.  In the last hour, Dr. Iparraguirre gave us a lecture on the approach to rashes in the ED.  The conference then concluded with an R4 clinical soap box lecture by Dr. Dang on the history of cannabis and medical marijuana, as well as the research behind its current use.  

Read More

Grand Rounds Recap 2.7.18

/
Grand Rounds Recap 2.7.18

This week Dr. Carleton kicked off a lecture series on the pediatric airway by discussing some anatomic and physiologic challenges as well as predictors of difficulty. In the latest installment of our Global Health lecture series, Dr. Lagasse gave us a great review on the unique uses of point of care ultrasound in a resource limited setting. Our R1 Diagnostics curriculum was continue by Dr. Gleimer who discussed the use of PFTs in the ED setting and Drs. Ham & Wright finished things up with an altered mental status CPC presentation. 

Read More

Interpretation of Pulmonary Function Tests in the ED

/
Interpretation of Pulmonary Function Tests in the ED

While formal pulmonary function testing is not often (if ever) performed in the ED, many patients with a history of COPD, asthma, CHF, sarcoidosis, etc, have had pulmonary function testing performed in the past.  Having an understanding of the underlying pathophysiology of these conditions, physiology of the lungs and respiration, and understanding of how the testing is performed is critical to being able to appropriately interpret the results of these test and apply the test results to our patients.

Read More

Grand Rounds Recap 1.31.18

/
Grand Rounds Recap 1.31.18

In this week's grand rounds, Dr. Stolz discussed all things DVT and the modified two-point compression study for lower extremity clots. In our recurring EM-neuro combined conference, Dr. Stettler discussed the recent DAWN trial results, and how to incorporate CT perfusion studies into our acute ischemic stroke decision trees. In our Quarterly Sim, we discussed the management of the crashing patient from a house fire, and practiced our escharotomy skills. In our mock oral boards, we went through cases on STEMI, carbon monoxide exposure and limb ischemia. Finally, Dr. Lane discussed the workup of acute diarrhea in the adult population, and Dr. Shah went through a particularly unique toxidrome presentation in his R4 Case Follow Up. 

Read More

It's Not "Just the Flu"

/
It's Not "Just the Flu"

This past month has seen the appearance and peaking of seasonal influenza in the Northern Hemisphere.  This year, a particularly early strain of flu has been causing widespread illness across all 50 of the United States.  The start (or height) of any flu season is a good time to refresh our understanding of the influenza virus, prevention strategies, testing methods, and treatment modalities.  This year, however, we also sit exactly 100 years removed from the most deadly global pandemic ever seen by humanity.  Try your hand at some flu-based trivia and take a listen to the podcast below (or on iTunes).

Read More

Grand Rounds Recap 1.24.18

/
Grand Rounds Recap 1.24.18

This week's Grand Rounds started off with our monthly Morbidity and Mortality conference with Dr. Titone.  This was followed by a lecture on pediatric bloody diarrhea with Dr. Shan Modi.  Dr. Claire O'Brien then gave her Clinical Soap Box lecture on cost and waste within the healthcare system.  Dr. Kreitzer then gave an evidence based lecture on current research in sepsis and refractory septic shock, followed by our consultant of the month lecture with Dr. Anthony Blanchard from podiatry discussing foot wounds and osteomyelitis.

Read More

Grand Rounds Recap 1.17.18

/
Grand Rounds Recap 1.17.18

This week's Grand Rounds started out with another installment of our leadership curriculum led by Dr. Stettler, where we discussed how to identify and manage finance in leadership.  This was then followed by Dr. Makinen's small group session on thyroid diagnostics in the ED.  Drs. Gauger and Loftus then went head-to-head on a case of syncope, found to have a massive PE.  Dr. Miller then gave a great summary of current thoughts and future approaches to sepsis, followed by Dr. Murphy discussing post-ENT procedure bleeds in the ED.  Dr. Curry then finished off the conference with his "Mastering Minor Care" segment on epistaxis.   

Read More

Interpretation of Thyroid Studies in the Emergency Department

/
Interpretation of Thyroid Studies in the Emergency Department

Thyroid studies, often lying in the depths of any medical student differential, are an important tool in the Emergency Physician's toolkit, and knowing what to order when is a key part of using them wisely. This week, Dr. Makinen gives us a breakdown of thyroid pathology and testing.

Read More

Grand Rounds Recap 1.10.18

/
Grand Rounds Recap 1.10.18

Grand rounds this week started off with a review of the EMTALA law with Dr. Hinckley, as well as some case discussion.  This was followed by a presentation from our clinical pharmacists, PharmD's Nicole Harger and Madeline Stephens, on anti-epileptic medications and their uses, as well as an update on our medication supplies in the ED.  Drs. Murphy-Crews and Scanlon then presented their evidenced based algorithm for the management of STEMI, followed by our combined peds EM lecture with Dr. Kevin Overmann on the evaluation of the pale child and pediatric anemia.  This was followed by Dr. Ludmer's R4 case follow up/best of residency cases.  The day finished up with Dr. Sim Mand presenting her clinical diagnostics lecture on the assessment and management of the non-pregnant patient with abnormal uterine bleeding. 

Read More