This is not your typical REBOA podcast. This is a discussion on logistics. This podcast is all about issues that flight teams or critical care transport teams need to consider when transporting a patient who has a REBOA place.
Read MoreCase 1: 45 yo male comes to the ED after being found down at the mall s/p defib x2 for a V fib arrest per EMS with a King Airway in place and undergoing active CPR. In the ED you achieve ROSC after defib x1 for Vfib and then PEA with multiple arounds of epinephrine. EKG shows inferior STEMI.
Case 2: EMS calls with advanced noticed for GI bleed presents tachycardic and hypotensive, actively bleeding with melanotic stool and hematemesis.
Read MoreThis is our first of 2 cases exploring the care of patients with sepsis in the Emergency Department. Similar to our "Out on a Limb" case series, the case presented is followed by a series of questions, with a discussion in the comment section facilitated by the post authors. In approximately 1 month (November 11th), the authors of the post will conduct a combined simulation/small group session reinforcing the learning points from the posts during Grand Rounds. Around this time, they will also curate the comments from the discussion and publish a post highlighting these learning points. Looking forward to a great discussion!
Read MoreThis is our first of 2 cases exploring the care of patients with sepsis in the Emergency Department. Similar to our "Out on a Limb" case series, the case presented is followed by a series of questions, with a discussion in the comment section facilitated by the post authors. In approximately 1 month (November 11th), the authors of the post will conduct a combined simulation/small group session reinforcing the learning points from the posts during Grand Rounds. Around this time, they will also curate the comments from the discussion and publish a post highlighting these learning points. Looking forward to a great discussion!
Read MoreI don’t know if this has happened to you yet. It happened to me on my first shift as an intern. I hadn’t laid hand on a stethoscope in months. I had just unloaded the cardboard boxes from my rental truck into my new place. As I was settling in to my first few patient encounters one of our nurses approached me to say that a patient had been brought into our area that was extremely agitated. I looked up to see a man being held down by multiple police officers, thrashing and swearing.
“What can I give him?” She said.
“How about a hug?” I replied.
Read MoreYou have inherited a patient in the VA MICU at signout. The patient presented with spontaneous bacterial peritonitis and altered mental status and was intubated for airway protection and hypoxic/hypercarbic respiratory failure. The patient’s altered mental status has resolved but the patient remains intubated waiting for a second large-volume paracentesis that can’t be done over the long weekend at the VA. The RT calls you asking for a one time dose of 5mg Versed, but on a quick glance at the chart, the patient has been getting these Q2 hours for the last several days. You go to the bedside and find an agitated patient motioning to take out the tube. “He’s bucking the vent doc!”
Vent settings: AC-VC: TV500 RR12 PEEP8 FiO2 30%
Read MoreCases reviewed were from the month of August. We saw greater volume in 2015 than 2014 with longer ED hold times. We reviewed multiple cases including:
Acute Inflamatory Demyelinating Polyneuropathy
There are many risk factors for septic arthritis including age >80, Diabetes, Rheumatoid Arthritis, recent joint surgery, prosthesis, cellulitis. The absence of risk factors does not make septic arthritis less likely in an acute monoarticular arthritis
Monoarticular arthritis is often characterized as a warm, painful, swollen joint with limited range of motion. No studies to date have quantified specificity data on the physical exam. Therefore, clinicians must use their own clinical gestalt when interpreting physical exam findings.
Read MoreThere isn't a day that goes by in the ED that a patient does not get a chest x-ray. Whether the indication is chest pain, shortness of breath, cough, or line placement or intubation, interpreting chest radiographs is a critical, necessary skill for anyone working in the Emergency Department. Here you will find a brief video explaining how to interpret CXRs and 6 practice cases.
Read MoreThis week was a tour of all the little things that make the ED a fun place to work. We're not talking about ECMO or REBOA, we're talking minor care.
Read MoreWhat do I need to assess before I load this patient in the heli?
Sometimes an issue’s theme is evident from the beginning- a well planned coordination of cases and perspectives that delivers a set message. Other times, an issue’s theme develops itself over the course of publishing the issue- a common thread manifests itself to us as editors as the issue comes together. Every so often, as was the case with this issue, AOBP ends up like a B-pod shift itself- a glimpse of the vast and varied pathophysiology that can present to us as Emergency Physcians at any point.
Read MoreThe Sick Patient with Pulmonary Artery Hypertension (PAH)
The patient is a healthy 3 week old male with no past medical history. He was born full term via uncomplicated Cesarean Section who presents with increased fussiness. His mother states the patient has simply not been acting like himself. He was taken home on hospital day 1 without issues, but in the last 24 hours, he has been quite fussy. His mother became concerned when he was unable to take his bottle today. The child has been refusing to eat and has been increasingly difficult to console. He has also had less wet diapers than normal today. Mom has not noticed cyanosis during feeding, recent illnesses or fevers. She also denies the presence of emesis, diarrhea, rashes, congestion, or cough.
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.
