Laboratory Evaluation of Sickle Cell Disease in the ED

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Laboratory Evaluation of Sickle Cell Disease in the ED

Given the morbidity of sickle cell disease, these patients frequently present to the emergency department, raising questions of: what laboratory testing is needed in these patients? And, how do we interpret commonly ordered labs in these patients? This article will discuss the basic principles of these commonly ordered studies in hopes of delineating when they are necessary and how they can help in the evaluation of the sickle cell patient presenting to the emergency department.

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Annals of B-Pod: Disseminated Intravascular Coagulapathy

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DIC is a much dreaded dysregulation of the body's natural coagulation infrastructure associated with very high morbidity and mortality. DIC is a diagnosis that emergency providers cannot miss, and in his case Dr. Shaw walks us through the timely identification and treatment of DIC in the emergency department while simultaneously shedding light on much of the controversy that surrounds DIC. Do blood products help correct the coagulopathy?  Find out inside!

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Annals of B-Pod: Ulnar Artery Pseudoaneurysm

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Annals of B-Pod: Ulnar Artery Pseudoaneurysm

Pseudoaneurysms are a potentially deadly complication of any traumatic injury to or manipulation of a patient's vascular structures, and are highly morbid when not identified and treated appropriately by medical personnel. In this fascinating case, Dr. Klaszky walks us through the presentation, diagnosis, and management of a traumatic pseudoaneurysm.

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Annals of B-Pod: Thrombotic Thrombocytopenic Purpura

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Annals of B-Pod: Thrombotic Thrombocytopenic Purpura

TTP, ITP, HUS, DIC - the category of hematologic emergencies is rife both with three-letter acronyms and potentially devastating complications for those patients afflicted with them. Told from the perspective of an internist, this article by medicine chief resident Dr. Baez details a case of thrombotic thrombocytopenic purpura (TTP) through the entirety of the patient's care, beginning with its presentation in the ED and ending with patient's ultimate recovery. In this article, Dr. Baez also details the newly minted, clinically-validated PLASMIC score, a scoring system that can be used in the ED to facilitate diagnosis of TTP. Check it out!

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Grand Rounds Recap 12.20.17

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Grand Rounds Recap 12.20.17

The final Grand Rounds of 2017 opened with Morbidity and Mortality led by Dr. Kari Gorder. Drs. Liebman, Banning, and Owens then shared exciting Global Health cases from their travels to Tanzania and Guatemala. Dr. Grace Lagasse gave her soapbox lecture on firearm violence and the Emergency Department. Finally, our dentistry colleagues Drs. McMahon and Dagher refreshed our techniques and skills in the management of dental trauma.

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Grand Rounds Recap 12.13.17

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Grand Rounds Recap 12.13.17

In the penultimate Grand Rounds of 2017 Drs. Klaszky and Spigner gave us an in-depth look of the evidence behind treatment of asthma in the ED and walked up through their new QI/KT pathway. Dr. Summers provided a great review of the resuscitation of the burn victim. We closed things out with our quarterly PEM-EM combined simulation sessions which included cases of children with difficulty breathing, seizure and stridor. 

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Grand Rounds Recap 12.6.17

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Grand Rounds Recap 12.6.17

We had a jam packed Grand Rounds this week kicked off by Dr. Carleton's airway lecture discussing tools to maximize fiberoptic intubation success. Next Drs. Roche and Plash led us through wilderness medicine small groups discussing plant ingestions and creative extrication techniques. Drs. Murphy-Crews and Bryant participated in a CPC case with a seizing neonate followed by Dr. O'Brien's discussion of blunt neck trauma. Next Dr. Cotton presented data on physician burnout and how to combat it while Dr. Li wrapped things up with an overview of Kawasaki's disease. 

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Grand Rounds Recap 11.29.17

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Grand Rounds Recap 11.29.17

This week Dr. Lagasse gave us a great M&M covering intra-ocular foreign bodies, empyema management in the ED and septic cardiomyopathy. Dr. Iparraguirre lead small groups in EKG case studies in heart blocks, followed by Drs Nagle and LaFollette squaring off in a CPC of an undifferentiated patient with aphasia. Drs Goel and McKee wrapped up this week with a clinical soapbox on patient turnover and a case follow up of lytics in massive PE.

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Heart Blocks: A Primer

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Heart Blocks: A Primer

We order and interpret numerous EKG’s during our shifts in the emergency department. EKG interpretation is one of the skills we need to be competent in and comfortable with as an emergency medicine physician. STEMI’s, ischemic changes and arrhythmias are some of the most important findings we focus on, and although straightforward, heart blocks can be easily overlooked. The goal of this post is to go over some of the most common and clinically relevant conduction blocks, how to manage them and what their disposition are.

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Grand Rounds Recap 11.8.17

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Grand Rounds Recap 11.8.17

This week, we started things off with a great Quarterly Sim led by our faculty. The oral boards cases, led by Drs Stettler and Roche, involved an acute presentation of holiday heart, a post-partum patient with flash pulmonary edema, and a very questionable spider bite. The simulation, led by Drs Fernandez, Hill and Stolz, focused on two patients that were in shock: one due to a ruptured ectopic pregnancy and one due to a pericardial tamponade. We then moved on to the pediatric side of things, where Dr. Gleimer discussed neonatal rashes, and we took a look at pediatric syncope with Dr. Fananapazir. 

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Grand Rounds 10.25.17

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Grand Rounds 10.25.17

Dr. Ludmer kicked things off with this month's Morbidity & Mortality conference where we discussed C. Diff, spinal cord compression, LP in the setting of anticoagulation and cardiac arrest with an LVAD. Dr. Stettler led the next segment of our longitudinal leadership curriculum with a look at the mentor/mentee relationship. We finished up with a soapbox lecture by Dr. Titone on conflict resolution and an R3 follow up by Dr. Bernardoni who discussed the crashing patient with right ventricular failure and pulmonary arterial hypertension. 

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Global Health: Reemerging Infectious Diseases

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Global Health: Reemerging Infectious Diseases

Global is local. It is important as health care providers that we think about infectious diseases in terms of a global context. Reemerging infectious diseases represent a constant moving target for physicians and scientists. Understanding some of the factors behind disease reemergence as well as examples of current reemerging infectious diseases helps to illustrate how local changes can have a global effect. 

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