Don't Kill the Beans: The Specter of Contrast-Induced Nephropathy

Don't Kill the Beans: The Specter of Contrast-Induced Nephropathy

Working in the Emergency Department, we often encounter patients with either pre-existing renal disease or an acute compromise of their renal function who also have a disease process necessitating a contrasted radiology study.  So what do we do with that patient with a creatinine of 1.8 who has a possible vascular dissection/traumatic injury/infection? What is the risk of contrast to that patient?  Should you compromise your diagnostic evaluation to avoid a harm to the patient's renal function?  Dr. Nick Ludmer, Dr Michael Miller, and Dr. Amanda Polsinelli recap 3 articles recently published looking into contrast induced nephropathy.  Take a listen to the podcast and read the blog post to get yourself acquainted with the current state of the literature.

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Vasopressin: A Second Class Pressor?

Vasopressin: A Second Class Pressor?

This week we'll be recapping the discussion of our most recent journal club where Dr. Christian Renne, Dr. Anita Goel, and Dr. Maika Dang led us in a discussion centering on the use of vasopressin both in sepsis and in vasoplegic shock states.  Take a listen to the podcast below and read the brief summaries of their articles to boost your understanding of Vasopressin.  Should you reach for it first or is it a second class pressor?

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Dealing with the Wheezes

Dealing with the Wheezes

Asthma and COPD are 2 of the more common ailments responsible for patients presenting to an Emergency Department with complaints of shortness of breath.  Last week, we met as a residency and, led by Dr. Lauren Titone, Dr. Walker Plash, and Dr. Rob Thompson, discussed some newer literature for the treatment of these often intertwined conditions.  Take a listen to the podcast within to hear our thoughts and read the summary after the jump for the breakdown.

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Anti-Arrhythmics - What Good Are They?

Anti-Arrhythmics - What Good Are They?

Last week we had our first Journal Club of the year and had an excellent discussion of the evidence surrounding the use of amiodarone, lidocaine, and procainamide for ventricular dysrhythmias.  Take a listen to the podcast below and read up on the details of the papers below that!

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Grand Rounds Recap 10/21

Grand Rounds Recap 10/21

Morbidity and Mortality Conference with Dr. Curry

Acute Coronary Syndrome in Pregnancy

Epidemiology

  • Incidence reported at about 6/100,000 deliveries
  • Maternal mortality is between 5-9%
  • 75% are STEMI
  • 2/3rds are anterior wall MI (LAD or LM as the culprit vessel)

Risk Factors

Many of these are typical ACS risk factors but are less prevalent in the pregnant population

  • Older age (>35 years old for pregnancy is considered older age....yikes)
  • Hypertension
  • Diabetes
  • Obesity
  • Smoking
  • Dyslipidemia
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The Search for the Holy Grail: Assessment of Fluid Responsiveness

The Search for the Holy Grail: Assessment of Fluid Responsiveness

Last week our residents and faculty met for journal club in search of the holy grail.. err.. I mean, to talk about ways to assess volume responsiveness.  A couple of weeks back the PGY-1 and 2  residents met and discussed a number of questions they had about the care and management of patients with sepsis.  The discussion hit on a number of key topics: empiric antibiotic selection, timing of antibiotics, choice of vasopressors, etc.  Ultimately the group decided they wanted to take a closer look at non-invasive ways to assess volume responsiveness and guide resuscitation in septic patients.

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Procedural Sedation Cage Match

Procedural Sedation Cage Match

It's a typical busy post-Thanksgiving shift in the ED.  It seems like patients with acute decompensated heart failure, sepsis, NSTEMI's and a whole host of other ailments are tucked in every corner and crevice of the ED.  Just as you finish putting in orders on the last patient you saw, your next patient rolls by on an EMS stretcher.  You see from your computer that the patient is on a backboard and in a c-collar after what clearly was some form of traumatic event.  He's screaming in pain and holding his left leg flexed at the hip and internally rotated.  "Jeez, I bet that hip is dislocated," you say to yourself.

You know you're going to need to reduce this dislocation, to not do so would risk avascular necrosis.  Tammy, one of the nurses you are working with that day is already 2 steps ahead of you.  "Doc, we're getting everything set up for the sedation, you're going to need for that hip that's out. What drugs do you want us to pull up?"

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Transfusion in Trauma: One Ratio to Rule them All??

Transfusion in Trauma: One Ratio to Rule them All??

A couple weeks back we met for the first journal club of the year in our residency.  For this first session, we tackled the clinical conundrum of transfusion ratios in trauma.  The question came from a brainstorming session with the PGY-1 and 2 residents, where the following PICO question was derived:

Patients: Victims of both blunt and penetrating trauma in need of blood transfusion as a part of the their initial resuscitation

Intervention: high plasma and platelet to PRBC ratio transfusion

Comparison: low plasma and platelet to PRBC ratio transfusion

Outcome: Mortality (in patient and 30 day mortality)

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A Crack in the Ice? An In-Depth Breakdown of the TTM Trial

A Crack in the Ice? An In-Depth Breakdown of the TTM Trial

   Like many other Emergency Medicine residencies, we took the time in our last Journal Club to break down the Targeted Temperature Management Article.  There is tons out there in the #FOAMed space about this trial.  And, one of our 4th year residents, Dr. Trent Wray, took some extra time to break down the article in gory detail and put it into the context of the previously published literature.

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The Basics of Evidence Based Clinical Practice - Asking Good Questions

The Basics of Evidence Based Clinical Practice - Asking Good Questions

Evidence Based Clinical Practice (EBCP) is a way to bring the sometimes obtuse world of evidence based medicine to the bedside.  Instead of getting lost in p-values, ANOVA, student t-tests, multivariate logistic regressions, EBCP approaches evidence based medicine always through the lens of a patient under a clinician's care.  It is a process that starts with asking carefully crafted questions and efficiently searching for answers to those questions.  Subsequent analysis of the articles found in the clinician's searching seeks to answer: are the results valid? what are the results? and finally, how can one apply the results to patient care?

In this short video, we go through the crucial initial step of the process: asking a question.  Success in asking answerable, well crafted questions begets successful search strategies.

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