Just the thing for the faint of heart!

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Just the thing for the faint of heart!

As Emergency Physicians, we pride ourselves on taking care of critically ill, undifferentiated patients. As technology as advanced, we’ve been able to add more and more tools to our arsenal to help guide the management of these patients. One such tool is cardiac ultrasonography. It is able to give us dynamic information about the patient, rule out life threatening pathology such as tamponade, and even help guide resuscitation in cardiac arrest. All of this, however hinges on the physician having the knowledge and skills to employ this in our fast paced environment. Are your skills up to snuff? Find out after the jump!

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Grand Rounds Summary 10.18.17

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Grand Rounds Summary 10.18.17

This week Dr. Gottula gave us a great in-depth explanation into alloimmunization and the use of RhoGAM in the ED. Dr. Owens and Faryar participated in a CPC centered around a sickle cell patient with knee pain. Dr. Asghar from orthopedics discussed the management of spine fractures in the ED. Our visiting professor Dr. Gail D'Onofrio discussed the ongoing opioid abuse issues facing the country. Dr. Hall discussed industrial injuries while Dr. Polsinelli wrapped things up with a discussion about how to use EMR to report core measures. 

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Rh-D Alloimmunization Prevention in the Emergency Department

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Rh-D Alloimmunization Prevention in the Emergency Department

The risk of alloimmunization in pregnancy is one the EP faces every day, but what are we preventing? when do we need to consider increasing our RhoGAM dosing? and do you really need a type and screen for the same patient in the same pregnancy? Dr. Gottula gets to the bottom of the type and screen and presents a rational algorithm for working up the Rh status of the pregnant patient in the ED.

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Grand Rounds Summary 10.11.17

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Grand Rounds Summary 10.11.17

Dr. Stolz started Grand Rounds off with a great talk on lung ultrasound. Our consultant of the month, Dr. Hebbeler-Clark, gave a talk on patient safety and swarms. Dr. Lipshaw, a Peds-EM fellow, discussed the differential, evaluation, and management of congenital heart disease babies in the Emergency Department. Finally, Dr. Teuber ended with an interesting discussion on priapism. 

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Grand Rounds Summary 10.4.17

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Grand Rounds Summary 10.4.17

This week Drs. Jarrell and Nagel kicked off Grand Rounds with their evidence based review of the hypertension management in the ED. Drs. Gorder, Lagasse, O'Brien, and Polsinelli discussed the difficult management of the patient in both cardiogenic and septic shock, reviewed heart murmurs, and endocarditis. Dr. Bryant made us squirm with her Global Health quick hit case review of parasitology, Dr. Lane led a great group discussion about the utility of procalcitonin in adults, and Drs. Habib and Roche ended Grand Rounds with a great CPC case!

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Pro's and Con's of Procalcitonin

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Pro's and Con's of Procalcitonin

Procalcitonin was reviewed on Taming the SRU in the context of other biomarkers (ESR, CRP) last year with a grand rounds discussion of its utility in the setting of a febrile 7 week old. As procalcitonin has continued to gain traction in the world of pediatric EM – receiving evaluation as part of proposed protocols for management of febrile infants (1) and for its utility as an aid to diagnosis of Serious Bacterial Infection (2,3) – we turned our attention this year to procalcitonin’s use in adults. Procalcitonin testing has been studied and available for decades (as St. Emlyn’s noted in an update earlier this year), but has not really established itself in widespread use in adults (as EMDocs noted in a sepsis update in 2014). In this blog post, we take the approach of going back to what is known (and is NOT known) about the biochemical basics of this molecule to give context to the sometimes confusing smorgasbord of proposed applications for procalcitonin testing that exists in the literature.

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Grand Rounds Summary 9.27.17

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Grand Rounds Summary 9.27.17

Dr. Titone held a great in-depth M&M this month with cases from tuberculosis to typhilitis (which is a thing). Drs. Baez and Goel took us through cases of coding Torsades and coding Pine Sol ingestions, followed by Dr. Skrobut who delicately closed the day with a discussion of testicular complaints in the ED.

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Grand Rounds Summary 9.20.17

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Grand Rounds Summary 9.20.17

This week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls.  This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate.  Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula.  Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine.  Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.

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Annals of B Pod - Fall 2017 Issue Release!

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Annals of B Pod - Fall 2017 Issue Release!

In the Fall 2017 edition of Annals of B Pod, our focus is on ocular emergencies. Dr. Murphy-Crews starts off with a case of acute angle closure glaucoma. This is followed by a detailed discussion of infectious keratitis and a procedure piece focusing on ocular ultrasound. Dr. Jarrell details a case of a traumatic
lens dislocation. In addition to these ophthalmologic-focused articles, Dr. Habib expertly discusses placenta previa and important management techniques of patients with abnormal placentation. The recurring pharmacology article details medication safety in pregnancy. Finally, Dr. Scanlon's EKG Focus discusses the evaluation and management of wide complex tachycardias.

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The Future of Airway Management?

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The Future of Airway Management?

What is the future of airway management in the ED?  How can we make our practice more effective and more efficient?  In this journal club recap, we focus on 2 topics emerging in the literature - flush rate O2 for pre-oxygenation and head of bed elevation during intubation.

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

Since the turn of the century, lactate has become a mainstay in emergency medicine and critical care laboratories. Some clinicians may hate it, others may love it, but very few can feign apathy on the subject. The utility of lactate in the emergency department and the ICU in guiding resuscitations, predicting mortality, or identifying occult critical illness continues to be discussed in the literature, most fervently in the realm of sepsis. But what are the humble beginnings of this molecule? Most fundamentally, how is lactate generated in the setting of critical illness? And how did it come to be so firmly embedded in our understanding of the pathophysiology of critically ill patients?

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Grand Rounds Summary 9.13.17

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Grand Rounds Summary 9.13.17

'Twas a fantastic grand rounds.  Drs. Banning and Golden started it off taking us through the most recent evidence for management of sub-massive and massive PE, as well as presenting their algorithm to be published on Emergency KT.  This was followed by a global health lecture given by Dr. Lagasse, which covered a range of re-emerging infectious diseases.  Next, Dr. Bryant took us through multiple pediatric cases, and discussed her approach in determining whether to discharge, transfer, or treat pediatric patients with common / representative complaints.  Dr. Adeoye then took us through the history and development of our current approach to the management of acute ischemic stroke.  Dr. LaFollette then took us through an evidence based approach to removing things from where they shouldn't be in his edition of mastering minor care, discussing approaches to removing retained objects from ears and skin.  We then finished the conference with two interesting cases:  One presented by Dr. Sabedra that was followed by a discussion on the diagnosis and management of massive hemoptysis, and the other presented by Dr. Dang illustrating the differences and similarities hyperthermic toxidromes including NMS and serotonin syndrome as well as their management.  

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Angle Closure Glaucoma

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Angle Closure Glaucoma

For many emergency physicians, ophthalmologic complaints are seemingly shrouded in mystery and pose a distinct diagnostic and therapeutic challenge. What the heck is gonioscopy? Which eye does OU refer to again? Does latanoprost really change the color of your iris? In this case, we join Dr. Murphy-Crews as he parses the enigma of acute closure glaucoma, its pathophysiology, and the appropriate management in the emergency department.

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