Lymphedema and Its Mimics

Lymphedema and Its Mimics

Lymphedema is a progressive pathologic condition of the lymphatic system where interstitial accumulation of protein-rich fluid leads to subsequent inflammation, adipose tissue hypertrophy, and fibrosis [1]. The direct effect of this development and its long-term complications can lead to disfigurement, decreased mobility, and significant morbidity. While the management of lymphedema typically requires long-term therapeutic interventions outside of the role of the Emergency Department, a thorough understanding of this condition and its mimics will help Emergency Physicians appropriately evaluate and manage the broad presentation of “swelling”.

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Grand Rounds Recap 4.20.22

Grand Rounds Recap 4.20.22

This week’s Grand Rounds was all about emergency response and management in disasters with fantastic lectures by visiting lecturer and UC EM alum, Dr. Tom Blackwell, on the basics of disaster response, airport mass casualty incident response with Assistant Chief Ray Dabbelt, and recognizing and caring for patients with chemical-induced injuries with Dr. Calhoun.

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Grand Rounds Recap 4.13.22

Grand Rounds Recap 4.13.22

Join us as Dr. Frederick discusses a case of massive upper GI bleeding, Dr. Kletsel challenges Dr. Ham to a battle of wits in CPC, Dr. Chhabria spills the salt on ‘dysnatremias’, Dr. Frankenfeld discusses posterior strokes, and Our CCHMC PEM colleagues brief us on pediatric broken bones!

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Grand Rounds Recap 3.30.22

Grand Rounds Recap 3.30.22

Join us as we cover the true breadth of our specialty during this week’s Grand Rounds! Starting from an excellent, ultrasound-loving Morbidity and Mortality Conference with Dr. Walsh, we discuss end of life care in the ED as well as atypical agents for symptomatic relief with visiting professor Dr. Karen Jubanyik, identify and manage hernias of all types during Dr. Brower’s R1 Clinical Knowledge lecture and end with an inspiring talk on imposter phenomenon with Dr. Pulvino in her R4 Capstone.

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Grand Rounds Recap 3.16.22

Grand Rounds Recap 3.16.22


In this week’s Grand Rounds, Dr. Carleton reviews our new and old airway equipment and describes best approaches for ETT exchange, Dr. Laurence shares insight on creative approaches to asking questions, appreciative inquiry, and questioning barriers for patients, Dr. Glenn discusses atypical headache etiologies including IIH, giant cell arteritis, acute angle closure glaucoma, and trigeminal neuralgia, Drs. Kein and Adan match wits in a CPC case of digoxin toxicity, and our PEM colleagues take us through a case of a critically ill infant with a ductal dependent lesion.

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Atypical Headaches

Atypical Headaches

Headaches account for approximately 4 million, nearly 3% of all ED visits annually. [1] We classify headaches as either primary (benign) or secondary, with secondary headaches occurring due to underlying pathology. In the ED, the goal is to alleviate symptoms safely and effectively while excluding dangerous causes of headaches. While nearly 98% of headaches in the ED are primary or benign [2], ruling out secondary causes of headaches is imperative as failing to diagnose correctly may result in significant morbidity or mortality.

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Grand Rounds Recap 3.9.22

Grand Rounds Recap 3.9.22

In this week’s Grand Rounds, Dr. Gibler Visiting Professor and UCEM Alum, Dr. Chris Miller, shares his insight on emergency medicine leadership development and our role in healthcare’s evolution, Drs. Tillotson and Yates guide us through their evidence-based QI/KT protocol for hypertension evaluation and management in the ED, Dr. Sobocinski discusses the pathophysiology, presentation, and management of PRES and RCVS, and Dr. Wolochatiuk shares lessons learned and approach to bias in medicine during her R4 Capstone.

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Grand Rounds Recap 3.2.22

Grand Rounds Recap 3.2.22

We kicked off the month of March with a jam-packed Morbidity and Mortality Conference with Dr. Meaghan Frederick highlighting some of our amazing cases from downstairs including features on high sensitivity troponin, stridor and complicated alcohol withdrawal. Next up, Dr. Katherine Connelly walked us through how to troubleshoot in-transport alarms and failures of cardiac assist devices. Lastly, Dr. Bill Hinckley shared pearls of wisdom from his years at Air Care.

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Grand Rounds Recap 2.16.2022

Grand Rounds Recap 2.16.2022

In this week’s Grand Rounds, Dr. Li shares his evidence-based savvy on out-of-hospital cardiac arrest and termination of resuscitation, Dr. Freiermuth guides us through implementation science, Dr. Grisoli leads us through a case-based discussion of hemophilia diagnosis and treatment, and Drs. Finney and Jarrell go head to head over a case of Dapsone-induced methemoglobinemia.

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Grand Rounds Recap 2.9.22

Grand Rounds Recap 2.9.22

It was another riveting week of Grand Rounds here in Cincinnati! Drs. Kate Connelly, Shawn Hassani, Allie Hunt and Eddie Irankunda kicked us off with a high stakes simulation case and discussion of aortic and vascular emergencies. Dr. Irankunda then reflected on his journey through residency via the filter of the 1990's classic TV show, ER, with many life lessons along the way. After a brief operations update with Dr. Fermann, we finished up with a case-based discussion of evaluation of vomiting in pediatric patients during our monthly combined conference with our PEM colleagues from Cincinnati Children’s Hospital.

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Grand Rounds Recap 2.2.22

Grand Rounds Recap 2.2.22

In this week’s Grand Rounds, Dr. Laurence led us through an incredible and education Morbidity and Mortality Conference, Drs. Gillespie and Continenza worked through a dramatic case combining vision changes and rash, Dr. Wright reminded us to not forget the esophagus in our patients with chest pain and Dr. Connelly gave a fantastic overview of EMS provider education and systems structure in her R4 Capstone. Finally, our incredible visiting professor, Dr. Megan Rybarcyzk gave us insight into building an emergency medicine education program in the midst of a pandemic and provides tips and tricks for those seeking a career in global health.

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Grand Rounds Recap 1.26.22

Grand Rounds Recap 1.26.22

This week, we started off with an excellent journal club led by Drs. Ijaz and Mullen discussing interventions aimed at improving access to primary care from the Emergency Department and then followed along with Drs. Ferreri and Skrobut as they battled out a case of mysterious altered mental status during the crowd favorite, CPC. Dr. Pulvino reminded us that not all rashes are simple through her case follow up and Dr. Gobble took us on a deep dive of the diagnosis and management of gastroparesis and cyclic vomiting syndrome. Finally, we closed out the day with lessons in nasal endoscopy and cricothyrotomy from the airway guru himself, Dr. Steven Carleton.

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All that Pukes: Cyclic Vomiting Syndrome, Gastroparesis and More

All that Pukes: Cyclic Vomiting Syndrome, Gastroparesis and More

Nausea and vomiting accounts for one of the most frequent chief complaints we see in the emergency department. For those presenting with another complaint, N/V is often an associated symptom. Treatment of these symptoms not only improves patient satisfaction, but also decreases associated complications, like dehydration and electrolyte abnormalities.

The etiology behind a patient’s N/V is highly variable, with a broad differential that stretches across all organ systems. Although often an acute presentation, N/V is increasingly being linked to set of chronic disorders, such as gastroparesis (GP), cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS). While the work-up and initial evaluation in the ED is similar for all, specifically ruling out potentially life-threatening diagnosis or complications, the clinical presentation and management vary subtly between these syndromes.

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Grand Rounds Recap 1.19.22

Grand Rounds Recap 1.19.22

This week’s Grand Rounds featured some amazing content! Starting with Dr. Paulsen, our leadership curriculum session focused on processing and learning from failure. We then discussed IV contrast extravasation with Drs. Milligan and Wosiski-Kuhn as they debuted their QI/KT protocol. Dr. Crawford reminded us of the dangers of carbon monoxide and we closed the day with an excellent introduction to the benefits of simulation-informed design with Visiting Lecturers Dr. Chris Hicks and Dr. Andrew Petrosoniak.

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Grand Rounds Recap 1.12.22

Grand Rounds Recap 1.12.22

Joins us for another week of Grand Rounds as Dr. Moulds breaks down platelet disorders, Dr. Alden Landry joins us to discuss disparities in healthcare, Dr. Urbanowicz laughs her way through her R4 Capstone on the science of laughter, and we team up with our alloys at CCHMC PEM to learn about iron toxicity.

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