Mild TBI = GCS > or = 13
Why Consider a 6 hour CT scan?
ACEP policy: mild TBI patients with normal head CT and normal mental status can be discharged home
Read MoreThere has long been a concern for increases in ICP with administration of ketamine primarily stemming from reports of increased ICP in the Neurosurgery and Neuroanesthesia literature. These increases were described primarily in patients usually with CSF outflow obstruction undergoing elective neurosurgical procedures. In the time since these articles were published, the use of ketamine in a wide variety of patients with neurologic compromise has been reported. In fact, there have been a couple of recent systematic reviews and meta-analyses on this topic. These systematic reviews and meta-analyses have essentially analyzing all the same existing literature (which is generally poor in quality).
Read MoreWhen volumes are high, remember the patient experience can be improved by acknowledging wait times when entering the room and apologizing for their wait.
Transverse myelitis is a result of partial inflammation of the spinal cord that can sometimes lead to necrosis.
This season's issue of Annals of B Pod we highlight clinical cases from our ED's B Pod to feature some complex cases starting with simple chief complaints, emphasizing the point that the sickest patients evolve from the mundane. Flu season continues to plague us and every day we face the question of how far to take the clinical evaluation when we see generic complaints. The decision comes partly from objective data, partly clinical decision rules, and mostly from a non-quantifiable summation that is clinical gestalt.
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.
Read MoreIt's another back pain type of day in Minor Care. 3 hours into your shift and you've seen 6 patient's with back pain. You quickly evaluate them asking them about red flag symptoms, searching for signs of neurologic injury on your physical exam. As you talk to Jane, your next patient, you get worried she doesn't have simple musculo-ligamentous back pain. Jane has a history of IVDU and states her last use was 3 months ago. She cites some subjective fever and chills over the past several days along with aching low back pain which has been getting steadily worse. On exam, you find she is febrile with a temperature of 101.4, tachycardic to 110, with a normal blood pressure. She has midline upper lumbar and lower thoracic spinal tenderness to palpation.
Read MoreGrading the Severity of Hypothermia
Case 1 - 37 yo F, G3P2, no prenatal care, somewhere around 3rd trimester, presents with vaginal bleeding. She endorses feeling weak and dizzy and had 1 syncopal episode at home. On arrival, she is tachycardic and hypotensive (80s/60s), has cool extremities with weak peripheral pulse. Fundus is a few cm below xyphoid process. On a sterile speculum exam she has a large amount of bleeding and cervix is dilated to 3 cm. US shows IUP with good cardiac activity. She requires blood rescuscitation and admission to OB for delivery due to placenta previa.
Read MoreYou take a big breath and walk out of the SRU. After having just spent the last hour and a half caring for a hypotensive, actively vomiting variceal bleeder, a full arrest that you had to pronounce, and a GSW to the chest that went quickly to the OR, you are dreading to see the state of your Pod. As you are just about to sneak into your workstation to get your bearings, you’re flagged down by Mr. Finch, the patient in bed 2.
“What can I help you with sir?” <you>
“What do you mean, what can you help me with? Man just get my paperwork and let me get out of here. I’ve had it with this place. I’m tired of being a pin cushion and I’m not going to take this crap anymore.” <Mr. Finch>
Read More16yoF with 4 days of bilateral lower quadrant abdominal pain and diarrhea that was tachy, dry, and with a diffusely tender abdomen and some right-sided discomfort on pelvic exam with a mild leukocytosis.
Dr. Steuerwald's approach to listening to patient presentations: Pick out the main symptoms, get a time course, and listen for any other true "weirdness" then build your own timeline of events.
Here at Taming the SRU, where we’ve been SMACC-infatuated for more than a year now, it’s easy for us to forget that many of you out there are still unfamiliar with what the fuss is all about. SMACC is the Social Media and Critical Care conference. Its next iteration, the third annual (and first to occur in North America), is coming in late June in Chicago, and wild horses couldn’t keep us away. Taming The SRU is honored and stoked to be an Affiliated SMACC Website.
Isn’t this just another CME conference, you ask? Emphatically, no. Weingart has called it “simply the greatest medical conference in the history of the world,” and we don’t think this is hyperbole. SMACC aims not only to educate; SMACC aims to entertain, and mostly, to inspire. To quote smacc.net.au: “SMACC is a high impact academic meeting fused with cutting edge online social media to deliver innovation with education. The underlying ethos is to provide free online education with open access, in what has come to be known as ‘FOAM’ (Free Open Access Meducation).” Get this: all sessions will be recorded and released as videos or podcasts online on the affiliated SMACC websites following the actual conference, for free! And yet, hundreds of us will flock to Chicago to attend in person. Why? We’re addicted to the inspiration of FOAMed, and the maximum dose of this inspiration attainable is SMACC, live and in person. (Plus, we’re sick of just ‘favoriting’ Minh Le Cong’s Tweets, and we want to shake his hand or give him a big ‘ol bear hug.) This is not your father’s medical conference. It’s infinitely better.
SMACC also aims to connect people across boundaries, and succeeds in doing so like no conference ever has. Wherever you practice critical care (prehospital, ED, OR, ICU), SMACC is for you. Whatever your discipline (student, EMT, medic, nurse, PA, NP, CNS, CRNA, doc), SMACC is for you. Whatever your specialty, whatever your experience level, whatever country you call home, whatever your clinical setting: as long as you seek inspiration to be as good as you can be at optimizing your sick patients’ outcomes, SMACC is for you. Right now, go to the brochure and look at it for just 60 seconds. Can you get a witness? You bet. Listen to this brief podcast in which Bill Knight, Jeff Hill, and I testify about the reasons for our excitement about our upcoming road trip to Chi-town. Still not sure? Check out the archives from SMACC 2014 (Gold Coast, Australia). We think you’ll be convinced. But, be forewarned: there’s no cure for SMACC addiction.
78 year old male with past medical history coronary artery disease status post stenting, hypertension, hyperlipidemia, chronic kidney disease presents with a chief complaint of double vision, feeling off balance. Patient states he awoke this morning with double vision. He states this sensation of double vision is worse when he looks side to side, and completely resolves when he closes one of his eyes. He does not wear glasses or contacts and denies any eye pain or trauma. Also, since this morning he has felt somewhat off balance, however denies any focal numbness or weakness of extremities. He noted an episode of slurred speech approximately 1 hour prior to arrival that has since resolved. No other difficulties with word finding or language. Otherwise patient denies headache, head trauma, neck pain, chest pain, or shortness of breath. He has not had symptoms like this in the past.
Read MoreYou are talking to your new patient, John. He's a pleasant 30 year old man who, by your estimation appears to be a victim of HGS... Holiday Gluttony Syndrome. John presented to you in the ED with abdominal pain, nausea, and vomiting. He goes on to tell you all this started after he chowed his way through a few too many Buckeyes. You see every Christmas, his mom sends him a far too large tin of Buckeye candies, which John had eagerly eaten and eaten and eaten, until the belly pain hit.
Read MoreOur good friend Jim DuCanto visited us earlier this year. We spent several days sharing knowledge and perspectives.
Part of our time together was spent recording this podcast. It has been simmering and is finally available for listening. Within, we briefly go through the history of the extra-glottic device (EGD) in general, and then, we talk about the Laryngeal Mask Airway (LMA) and its “descendants” in great detail.
Jim really had a tremendous wealth of knowledge to share…
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.
