Air Care Orientation Case #1

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Air Care Orientation Case #1

This is Case #1 of our Air Care Orientation Curriculum!  This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians.  These cases are discussed amongst our training flight docs and this is the resultant learning points.  In this case, we discuss a sick trauma patient that needs multiple interventions.  But what interventions need to be done?  In what order?  And who should do them?  Read on to find out!

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EKG Toxicology

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EKG Toxicology

Emergency medicine physicians frequently assess and treat patients who have accidental or intentional poisonings. United States poison centers receive over two million case referrals per year. And, about 20% of these poisonings present to an Emergency Department for evaluation. Evaluation of these patients always includes a history and physical, but further testing can provide valuable information. Blood work is often be needed, but an EKG is a faster, cheaper tool that can provide key pieces of information prompting early interventions. 

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Grand Rounds Recap 3.14.18

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Grand Rounds Recap 3.14.18

This week's Grand Rounds opened with Dr. Curry discussing the paucity of literature on double defibrillation in VF. Dr. Mand then led small group discussions about the clinical utility of the pelvic xray. This was followed by Dr. Kreitzer expertly identifying incomplete Brown-Sequard Syndrome in Dr. Banning's CPC. Dr. Liebman discussed an interesting presentation of meningitis in a pediatric patient. Finally, our PEM colleagues led case based presentations of pediatric DKA, cat scratch disease, and a simulation featuring a patient in hypothermic cardiac arrest.  

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Back to Basics: Pelvic XRays

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Back to Basics: Pelvic XRays

Pelvic Xrays are a key component of trauma, fractures and dislocations seen every day in the ED, but when is the last time you went back over the anatomy and radiographic tips and tricks of the pelvic radiograph? Join Dr. Mand's thorough break down of this commonly used ED diagnostic - the Pelvic XR.

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Grand Rounds Recap 3.7.18

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Grand Rounds Recap 3.7.18

The first Grand Rounds of March opened with guest lecturer and UCEM alumni Dr. Matthew Valento discussing his career in toxicology as well as synthetic cannabinoids. Drs. Habib and Ham then discussed the evidence-based workup, management, and treatment of mammalian bites. Drs. Baez, Bernardoni, Randolph, and Shaw lead various small group sessions focused on high yield urological clinical knowledge, procedures, and trouble shooting techniques. Dr. Titone continued the midday genitourinary theme with her approach to the management of patients with indwelling urological drains and stents. Dr. Koehler ended the day with a discussion of high yield toxins.

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Minor Care Series: Corneal Abrasions

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Minor Care Series: Corneal Abrasions

Minor Care series is back with more from the red eye!  We've already covered conjunctivitis and scleritis, now for another high yield topic: Corneal Abrasions!  Everyone seems to have their own way of treating these patients, but is it evidence based?  Read on to find out what the literature says about this common complaint.  

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The Anatomy of Femoral Vascular Access

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The Anatomy of Femoral Vascular Access

Prior to the widespread availability of point-of-care ultrasonography, invasive medical procedures were performed by the “landmark method”.  Landmark methods are based on surface anatomy, palpation, and sometimes trigonometry, and are fraught with the potential for error.  Complications, while unquantified in the misty past, were likely much more common than in the current era of readily available bedside imaging.  Vascular access procedures are inarguably safer and more successful when guided by sonography, but interpretation of ultrasound images still requires an understanding of both surface and deeper anatomy to relate the two-dimensional screen image to three-dimensional reality.  Further, there are circumstances where either the urgency of the resuscitation, or compromised access to the patient, requires that vascular access be obtained using landmarks rather than real-time imaging.  In such cases a detailed understanding of regional anatomy is critical to maximize procedural success and minimize complications.

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Global Health: Case Series

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Global Health: Case Series

The Global Health case series highlights interesting cases residents experienced while practicing abroad and takes a dive into how to identify the pathology that is crucial know to care for patients both abroad and returning. Dr. Colmer continues this year's case series with a case of an adult patient with a "textbook" rash he saw while in Tanzania.

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Grand Rounds Recap 2.21.18

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Grand Rounds Recap 2.21.18

This weeks grand rounds started off with our monthly Morbidity and Mortality with Dr. Lagasse.  We then discuss in Aircare grand rounds led by Drs. Dang and Renne the always harrowing complex patient transfers including LVAD, EKOS and more.

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A Pain in the Neck

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A Pain in the Neck

There are some areas in our practice where the literature grants us a somewhat sure path forward in the evaluation of our patients.  The decision whether or not to pursue cervical spine imaging studies following a traumatic mechanism of injury is one of these areas.  The NEXUS criteria and Canadian C-Spine Rule are useful guides for the evaluation of these patients.  What comes after the imaging can be a bit more challenging.  What do we do with patients who have persistent pain but negative imaging? To what extent do we pursue the possibility of a ligamentous injury? Must we wait for all patients to be sober so that we can "clinically clear" them in addition to our radiographic clearance.   The 3 articles below seek to answer some of these challenging questions.  Take a listen to the podcast and read the summaries to familiarize yourself with some of the latest literature addressing these challenging patient care scenarios.

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Grand Rounds Recap 2.14.18

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Grand Rounds Recap 2.14.18

This weeks Grand Rounds was started off with our guest lecturer, Dr. Esther Choo, who gave a compelling talk regarding gender disparities in medicine and the effects of gender bias in our profession and every day practice.  This was followed by Dr. Owens and Ventura giving their evidence based approach to the management of A-Fib, as well as previewing their upcoming algorithm for Tamingthesru.com.  Our pediatric EM colleague Dr. Valentino then walked us through current recommendations on the approach to the febrile infant.  In the last hour, Dr. Iparraguirre gave us a lecture on the approach to rashes in the ED.  The conference then concluded with an R4 clinical soap box lecture by Dr. Dang on the history of cannabis and medical marijuana, as well as the research behind its current use.  

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When the Easy LP Isn't Easy

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When the Easy LP Isn't Easy

Lumbar punctures can be mercurial procedures.  There are certainly patients in whom it can be predicted that a lumbar puncture will be challenging.  Obesity, patients with known degenerative changes, and agitated patients all present unique challenges when it comes to successfully completing a lumbar puncture.  There are patients, however, who throw you a bit of a curveball.  Sometimes cooperative patients with good landmarks, in whom you had every expectation that you would find success, become seemingly impossible to successfully complete a lumbar puncture.  

For the provider, knowing how to troubleshoot the unexpectedly difficult lumbar puncture can be the difference between success and failure.

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