Pneumonia Alphabet Soup

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Pneumonia Alphabet Soup

Pneumonia. It’s one of the first conditions we learn to diagnose as medical students. It was probably the cause of the first really sick, septic geriatric patient you saw in residency. Conversely you have also probably sent a fair share of patient’s home with an outpatient course of antibiotics and PCP follow-up.  While determining the appropriate treatment and disposition for patients on the extreme ends of illness severity is quite straight forward; that pesky majority in the middle can be a conundrum at times. Who can go home? Who needs broad spectrum? Who needs step-down? Over the last two decades there has been a smorgasbord of pneumonia related acronyms used in clinical practice to predict severity, guide therapeutics and recommend disposition. During our most recent resident Journal Club, we took a look at a handful of the more familiar acronyms as well as some new ones coming down the pipeline.

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Grand Rounds Recap 2.20.19

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Grand Rounds Recap 2.20.19

This week’s grand rounds started with Dr. Colmer reviewing some fascinating cases in this months Morbidity and Mortality. We then split up into groups and did the quarterly sim focusing on informed consent led by Drs. LaFollette and Lang. This was followed by some challenging oral boards cases chosen by Drs. McDonough and Hill. Look forward to next week!

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Grand Rounds Recap 2/13/19

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Grand Rounds Recap 2/13/19

This week, we started Grand Rounds with ED-critical care research brought to us by UC Alumnus Dr. Brian Fuller. He discusses ventilator management in the ED and how ED sedation may affect patient outcomes. Dr. Harrison then presented an overview and common utilization errors of ED observation from his year as a Resident Assistant Medical Director, followed by Dr. McKee’s case of inhalational chlorine exposure. Dr. Alwan discussed updates to the less than 60 day fever protocol at CCHMC and Dr. Zozula walked through the dispatcher assistance protocols to give us an idea of what happens before they enter the ED doors.

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Grand Rounds Recap 2/6/19

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Grand Rounds Recap 2/6/19

It was an exciting week of Grand Rounds! We had the honor of hearing from legendary UCEM graduate Dr. Susan Stern who was the Dr. Gibler Visiting Professor. She discussed hemorrhage in trauma and the changing landscape of leadership in medicine. This was followed by operations updates with Dr. Palmer, and Dr. Laurence discussed AIDS-defining illnesses in her clinical knowledge lecture. The day concluded with a review of some Air Care cases. Check it out!

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Grand Rounds Recap 1.30.19

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Grand Rounds Recap 1.30.19

Welcome to another grand rounds recap! This week Dr. Isaac Shaw started us out with the monthly Morbidity and Mortality. Dr. Stolz then dove into some ultrasound QA, covering topics such as knee arthrocentesis and early pregnancy ultrasound. Dr. Murphy followed this up by discussing the science of motivation and how we can use this in the Emergency Department setting. This was followed up with Drs. Modi and Kircher who went head to head in this months CPC on endocarditis. Dr. Irankunda finished up the day with an excellent talk on the retrograde urethrogram. See you next week!

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Grand Rounds Recap 1.16.19

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Grand Rounds Recap 1.16.19

Welcome to another Grand Rounds Recap. This week Dr. Sayal, a visiting lecturer from North York General Hospital in Toronto, Canada, started us off with some pearls and pitfalls for the patient presenting with musculoskeletal complaints. Next up was Dr. Thompson who provided us some tips on how to prevent the most common patient and consultant complaints in the emergency department. Dr. Habib then led us through an interesting case involving an internal degloving injury. We then ended the day with small groups and a simulation led by Drs. Baez, Shaw, and Summers involving emergency obstetrical presentations. Be sure to check out the video of Dr. Isaac Shaw’s peri-mortem c-section simulation. See you next week.

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Grand Rounds Recap 1.9.19

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Grand Rounds Recap 1.9.19

We are excited to share our latest installment of the Grand Rounds Recap with you! Dr. Stettler opened the day with a discussion on leadership styles and how they affect our practice in the emergency department. Next up was Dr. Sabedra with a riveting case of new onset heart failure and acute ischemic stroke in a patient in his twenties. Dr. Berger then gave us a shot to the gut, in a good way, with a lecture on colitis. We then delved into the world of pediatrics with a lecture by Dr. Gray who helps us standardize our approach to evaluating for the possibility of child abuse. Dr. Hughes and Dr. Gottula then ended the day with a practice changing summary of the current literature and a new pathway for the management of NSTEMI.

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Grand Rounds Recap 1.2.19

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Grand Rounds Recap 1.2.19

We had an excellent series of lectures this week at our Grand Rounds to welcome in the New Year! The esteemed Drs. Calhoun and Stettler started us off with our Great Debate series pitting Ketofol against Ketamine or Propofol alone for procedural sedation. The winner of this debate? Definitely the audience who got to soak up the expertise from these clinical giants. Next up was Dr. Leenellett who guided us through some community ED cases of early pregnancy vaginal bleeding in our Discharge, Transfer, or Treat lecture series. Dr. Laurence then led us through a small group case based discussion on the indications for massive transfusions in trauma. Then a hush fell over the crowd as Dr. Iparraguierre laid down the CPC gauntlet with a presentation of Myasthenia Gravis for Dr. LaFollete who masterfully identified the Ice Pack Test as the diagnostic test of choice! Next up was Dr. Colmer who gave some tips for the management of severe alcohol withdrawal with his case follow-up lecture. There was no knocking this knowledge train off the tracks as Dr. Urbanowicz led us through a harrowing discussion on Weapons of Mass Destruction. To round out the day Drs. Klaszky, Gauger, and Murphy Crews led us through some small group exercises on the NIH stroke scale, CT angiography of the head and neck interpretation, neurological emergencies jeopardy, and indications for performing a burr hole with some hands on practice (simulation of course!).

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Grand Rounds Recap 12.19.18

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Grand Rounds Recap 12.19.18

Come check-out our Grand Rounds Summary for 12.19.18! We started the morning with some fascinating cases in Morbidity and Mortality Conference with Dr. Baez. Next, we learned the importance and efficacy of mindfulness with Dr. Bernardoni. Dr. Makinen and Dr. Curry went head-to-head on a Clinical Pathologic Conference about a patient with hyperthermia due to sympathomimetic overdose. Lastly, Dr. Frederick taught us the evidence behind PECARN!

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To Scan or Not to Scan? PECARN for Pediatric Head Trauma.

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To Scan or Not to Scan? PECARN for Pediatric Head Trauma.

When a child comes in to the emergency department for head trauma, it can be difficult to balance unwanted, and possibly unnecessary radiation, with the risk of missing clinically significant head trauma. CT scans of the head allow providers to rapidly identify, and subsequently address dangerous and potentially life-threatening intracranial trauma and hemorrhages. However, as with everything in medicine, a CT scan is not without risks, particularly in the pediatric patient. With over 500,000 ED visits per year dedicated to pediatric head traumas, this is a challenge that emergency medicine providers face frequently (1).  A study published in 2001 suggests that approximately 170 deaths were attributable to one year of CT head examinations in pediatric patients (2), and utilization of CT imaging has only increased since. Therefore, as with any radiation based imaging, careful consideration should be given to whether the test is truly necessary. As mechanism of injury and post-trauma symptoms can range drastically, it can be difficult to accurately assess the appropriateness of imaging in a child. As such, the pediatric emergency care applied research network (PECARN) worked to develop a clinical decision tool to guide clinicians in the need for head CT following pediatric head trauma.

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Grand Rounds Recap 12/12/18

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Grand Rounds Recap 12/12/18

This was an exciting week of Grand Rounds discussions on a variety of topics. We began with a discussion of prehospital sepsis care and an update on EMS protocols in Southwest Ohio. The combined EM-Neuro conference provided a lively discussion on Guillain-Barre syndrome. The quarterly operations update was followed by a detailed discussion on esophagitis management in the ED. Finally, the pediatric fellows led a series of case discussions on a variety of devastating pediatric illness.

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Grand Rounds Recap 12.5.2018

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Grand Rounds Recap 12.5.2018

We had another excellent Grand Rounds this week! Dr. Carleton started us off with some thrilling airway cases in his continuing Airway Grand Rounds series. Next, we were transported to Africa for a case based discussion on Global Health with Drs Owens, Sabedra, Ventura, and Murphy-Crews. Dr. Skrobut and Chris Shaw then took us through a deep dive of the current literature on the management of upper GI bleeds. Dr. Ham then taught us about ACE-I induced angioedema through the lens of an amazing case of a patient who required a cricothyrotomy to save her life! Next up, we had Dr. Gleimer go up against Dr. Faryar in our Clincal Pathological Case series where we a classic presentation of Addison’s disease in a pediatric patient. Dr. Hunt then led us through small group discussions on the application of the HEART Score in patients presenting to the ED with chest pain. We wrapped up the day with Dr. Isaac Shaw who presented a the management of SVT in a complicated patient.

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Diagnostic Questions of the HEART

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Diagnostic Questions of the HEART

Chest pain is a part of our everyday practice, as has become utilization of the HEART score. Successfully weathering a storm of validation, it is incumbent upon us to know the data and variability to its use in the ED. This week Dr. Hunt will take us through the diagnostic view on the HEART score and the data behind it.

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Grand Rounds Recap 11.28.18

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Grand Rounds Recap 11.28.18

Check out this week’s recap of Grand Rounds! Dr. Tim Murphy took us through some fascinating cases with Morbidity and Mortality Conference. Next, we got to dive deep into toxicology. Dr. Kelli Jarrell led us through a case she had of a TCA overdose, Dr. Shawn Hassani taught us about Beta Blocker and Calcium Channel Blocker overdose, and Dr. Woods Curry took us through a oral boards session during Quarterly Sim reviewing Aspirin toxicity. Quarterly Simulation also had an oral boards case discussing inferior STEMI complicated by complete heart block, as well as an awesome simulation teaching the fundamentals of teamwork and closed loop communication by having a lucky R3 run a code with a blindfold on. We’re excited to share the learning highlights with you!

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Grand Rounds Recap 11.14.18

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Grand Rounds Recap 11.14.18

We had a great Grand Rounds line-up this week - Dr. Whitford started us off with a challenging case of altered mental status that took a variety of twists and turns highlighting the need for reassessment flexibility in your differential diagnosis in the critically ill patient. Next up was Dr. Koehler and Dr. Betz who led us through a case of septic arthritis which presented atypically as altered mental status. Dr. Edmunds then provided us with emergency presentations of pediatric vomiting. Lastly, we closed the day with Dr. Roblee’s excellent case-based discussion on the evaluation and management of hypertension in pregnancy.

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