The first of a new series of posts with associated podcasts looking at the literature behind what we do every day in the ED with takeaways of tangible algorithms to guide every day practice. This month Drs Gauger and Harty lead us in a discussion of cardiac arrest, the drugs we use, the ultrasound we dabble with and the future interventions that could become standard of care.
Read MoreWhen a patient with a history of recent IVDU presents with a complaint of fever, the mind of the provider should immediately focus on the numerous possible infectious complications that can arise. Infectious endocarditis can lead to septic emboli spread to any organ system. Pneumonia can result from aspiration or septic embolization. Cellulitis/abscess can obviously result from local injection. But what about when a source of fever is not readily identifiable? When cultures are negative and the patient’s symptoms have resolved, what could have been the cause of their febrile illness?
Read MoreIn this post, we discuss necrotizing fasciitis and whether the LRINEC score is a useful decision-aid for the emergency physician when this disease is suspected.
Read MoreThis weeks grand rounds started off with a Morbidity and Mortality presentation by Dr. Baez including topics such as STEMI in LVH, pharmocologic cardioversion, and septic arthritis of the finger. This was followed by Dr. Freiermuth who gave us some pearls on the approach and management of sickle cell patients in the ED. Dr. Shaw then discussed some disturbing new health policy issues. Dr. Essell, a Heme/Onc attending at Jewish Hospital then walked us though GvHD, Acute Leukemia emergencies, and a fascinating new treatment option for blood cancers CAR-T. The day continued with a review of burn management by Dr. Spigner. Dr. Walsh then finished the day with an overview of carboxyhemoglobinemia and methemoglobinemia.
Read MoreThe week started off with our AirCare team discussing indications for procedures performed pre-hospital. The AirCare team continued by taking us through several cases in our quarterly AirCare M&M. We then got some oral boards practice with Drs. McDonough and LaFollette. The day finished with a simulation led by Dr. Hill covering patients who wish to leave AMA as well as the terrifying lengthening QTc.
Read MoreThe week started off with a discussion on research and ways to get involved during residency. We then got a primer on early pregnancy ultrasound and ectopic pregnancy from Dr. Stolz. Our yearly directives series covered personal finance/loans as well as the job search and contract negotiation. Dr. Stettler then gave us some pearls on how to manage the agitated patient. This was followed by Dr. Plash who discussed the removal of GI foreign bodies. We then ended with a visiting lecturer, Michigan Program Director Dr. Laura Hopson, who covered bedside teaching tips and tricks.
Read MoreThis week started with a discussion on how we can improve our documentation to maximize our level V billing. This was followed by a summary of practice changing literature over the last year, a discussion on how we deal with failure in the clinical setting, and a guide to the approach of the agitated pediatric patient. Finally, we broke into small groups to learn about ENT emergencies.
Read MoreChock full of didactic pearls, this week EM/Sports Medicine physician Dr. Betz started us off with a number of can’t-miss orthopedic injuries. Drs. Baez and Owens led us through case follow ups of air embolism and a sick neonate in shock. To finish up, Wilderness Medicine’s own Drs Mel Otten and Conal Roche taught us about marine and snake envenomations and dive injuries.
Read MoreThis week started with our monthly Morbidity and Mortality conference where we discussed posterior MIs, tough dissections and more tough cases. We then heard a debate on the use of D-Dimer in the diagnosis of aortic dissection. Finally, we were led through a simulation of a sick GI bleed requiring Minnesota tube placement, and we discussed optimal management of these challenging patients.
Read MoreThis week’s Grand Rounds started with a leadership session led by Dr. Stettler where we discussed the qualities of strong leaders and how we can use those qualities to implement change within our department and health system. Dr. Knight covered the management of concussions and spinal cord injuries in the emergency department. From there, Dr. LaFollette led us through a discussion of how to manage various ENT and ophthalmology complaints in the community setting.
Read MoreLet the new year begin! This year’s Grand Rounds kicked off with a series of topics covering why what we do matters, and that starts with how we as ED providers conduct ourselves. Dr. Palmer started us off with a discussion of teamwork, how to overcome difficult teamwork scenarios and overcome adverse encounters with integrity. Dr. Doerning gave some insights and lessons in analytics and a foray into datasets using ‘R’ and Dr. McDonough led the group in a talk and small group exercise in professionalism.
Read MoreIt is undoubted that effective airway management is a critical link in the care of patients with both in-hospital cardiac arrest and out-of-hospital cardiac arrest. But how exactly should one manage the airway? What results in the best outcomes for our patients? Should we be aiming to intubate every patient? Or, are extraglottic devices as effective (or more effective)? What about the good old bag-valve mask? In our most recent Journal Club we explored the evidence surrounding airway management in cardiac arrest, covering 3 high impact articles. We also touch on an abstract presented at the 2018 SAEM Academic Assembly which should add significantly to the body of literature when it is published in full. Take a listen to our recap podcast below and/or read on for the summaries and links to the articles.
Read MoreThe final Grand Rounds for the 2017-2018 academic year opened with a fantastic morbidity and mortality conference given by Dr. Ludmer. Dr. Randolph then gave us his approach to the dyspneic and hypoxic patient. Thanks for following us through this enriching and amazing year of education!
Read MoreThis academic year’s penultimate Grand Rounds started with Guest Faculty Lecturer Dr. Richard Levitan lecturing on airway tips, tricks, and trouble shooting. Drs. Harrison, Sabedra, and Summers then led small group sessions focused on unique applications of ultrasound. Dr. Hughes discussed TB management in the ED and Dr. Thompson closed out Grand Rounds with pearls on patient management.
Read MoreIn this week’s Grand Rounds, Dr. Polsinelli started us off with the diagnosis and management of aortoenteric fistula. We then discussed burnout and failure in our wellness curriculum in a small group setting, and heard from our colleagues in pharmacy about high-dose insulin therapy for calcium channel and beta blocker overdose. Dr. Roche led us in our Mastering Minor Care curriculum with a discussion of all things arthrocentesis, and we closed with a great combined PEM/EM simulation session and oral boards practice.
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.
