Annals of B-Pod: Osmotic Demyelination Syndrome

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Annals of B-Pod: Osmotic Demyelination Syndrome

It is said that that the relatively high salt content of human serum and cerebrospinal fluid stems from our ancestral ties to the sea, that we carry a bit of the ocean around inside of us as a legacy, an homage to the brave evolutionary progenitor that first crawled out of the water and onto land. Unfortunately, our bodies must work hard to maintain that hypertonicity. Small fluctuations in our serum and CSF sodium content can lead to significant swelling or, more devastatingly, pronounced shrinking. Dr. Frederick’s fabulous article deftly details the clinical entity known as osmotic demyelination syndrome. Soak up the presenting features, clinical management, and dire prognosis of this much feared but rarely seen pathology.

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Air Care Series: Sepsis Update

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Air Care Series: Sepsis Update

Katherine Connelly, MD reviews the literature surrounding the definition and management of sepsis both in the Emergency Department and Critical Care Transport Environment. We will cover pressor usage, as well as appropriate antibiotic coverage and if there is any role for steroids (for now…)

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Grand Rounds Recap 2.20.19

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Grand Rounds Recap 2.20.19

This week’s grand rounds started with Dr. Colmer reviewing some fascinating cases in this months Morbidity and Mortality. We then split up into groups and did the quarterly sim focusing on informed consent led by Drs. LaFollette and Lang. This was followed by some challenging oral boards cases chosen by Drs. McDonough and Hill. Look forward to next week!

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Global Health Case Series: “Global Worming”

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Global Health Case Series: “Global Worming”

The Global Health case series highlights interesting cases that 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. Although Dr. Owens did not participate in the care of the patients described in these cases, she expertly tackles a disease that has received a lot of media attention.

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Grand Rounds Recap 2/13/19

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Grand Rounds Recap 2/13/19

This week, we started Grand Rounds with ED-critical care research brought to us by UC Alumnus Dr. Brian Fuller. He discusses ventilator management in the ED and how ED sedation may affect patient outcomes. Dr. Harrison then presented an overview and common utilization errors of ED observation from his year as a Resident Assistant Medical Director, followed by Dr. McKee’s case of inhalational chlorine exposure. Dr. Alwan discussed updates to the less than 60 day fever protocol at CCHMC and Dr. Zozula walked through the dispatcher assistance protocols to give us an idea of what happens before they enter the ED doors.

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Grand Rounds Recap 2/6/19

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Grand Rounds Recap 2/6/19

It was an exciting week of Grand Rounds! We had the honor of hearing from legendary UCEM graduate Dr. Susan Stern who was the Dr. Gibler Visiting Professor. She discussed hemorrhage in trauma and the changing landscape of leadership in medicine. This was followed by operations updates with Dr. Palmer, and Dr. Laurence discussed AIDS-defining illnesses in her clinical knowledge lecture. The day concluded with a review of some Air Care cases. Check it out!

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Grand Rounds Recap 1.30.19

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Grand Rounds Recap 1.30.19

Welcome to another grand rounds recap! This week Dr. Isaac Shaw started us out with the monthly Morbidity and Mortality. Dr. Stolz then dove into some ultrasound QA, covering topics such as knee arthrocentesis and early pregnancy ultrasound. Dr. Murphy followed this up by discussing the science of motivation and how we can use this in the Emergency Department setting. This was followed up with Drs. Modi and Kircher who went head to head in this months CPC on endocarditis. Dr. Irankunda finished up the day with an excellent talk on the retrograde urethrogram. See you next week!

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The Importance of the RUG

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The Importance of the RUG

It is early on in your residency training, when you receive sign-out of a patient who was involved in an MVC with multiple injuries including a stable pelvic injury. The patient, a middle-aged male, has not voided three hours into his visit and there is no mention of any obvious genital trauma.  He has had a negative FAST exam in addition to the rest of your primary and secondary assessment. The patient mentions to the nurse that he is trying to urinate but cannot void and has some discomfort. The bladder scan shows that the patient has about 500cc of urine and when the nurse goes to place a urinary catheter she pauses as she sees what appears to be dried blood at the urethral opening. After reassessing the patient who is still hemodynamically stable with normal mentation, his findings are discussed with Urology who recommend getting a retrograde urethrogram prior to any additional procedures. 

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Grand Rounds Recap 1.16.19

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Grand Rounds Recap 1.16.19

Welcome to another Grand Rounds Recap. This week Dr. Sayal, a visiting lecturer from North York General Hospital in Toronto, Canada, started us off with some pearls and pitfalls for the patient presenting with musculoskeletal complaints. Next up was Dr. Thompson who provided us some tips on how to prevent the most common patient and consultant complaints in the emergency department. Dr. Habib then led us through an interesting case involving an internal degloving injury. We then ended the day with small groups and a simulation led by Drs. Baez, Shaw, and Summers involving emergency obstetrical presentations. Be sure to check out the video of Dr. Isaac Shaw’s peri-mortem c-section simulation. See you next week.

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The Head and the Heart: Hemodynamic Derangement in Isolated TBI

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The Head and the Heart: Hemodynamic Derangement in Isolated TBI

We know that alterations in hemodynamics do not only occur in hemorrhagic shock.  Both obstructive (such as from tension pneumothorax) and neurogenic shock (for example, from a spinal cord transection), can result in hemodynamic compromise that would not be corrected by blood product administration.  There have been some studies that have shown isolated traumatic brain injury (TBI) can also cause hemodynamic derangements. This article looks at a paper which attempts to examine the incidence of cardiovascular instability in patients with TBI.

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Grand Rounds Recap 1.9.19

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Grand Rounds Recap 1.9.19

We are excited to share our latest installment of the Grand Rounds Recap with you! Dr. Stettler opened the day with a discussion on leadership styles and how they affect our practice in the emergency department. Next up was Dr. Sabedra with a riveting case of new onset heart failure and acute ischemic stroke in a patient in his twenties. Dr. Berger then gave us a shot to the gut, in a good way, with a lecture on colitis. We then delved into the world of pediatrics with a lecture by Dr. Gray who helps us standardize our approach to evaluating for the possibility of child abuse. Dr. Hughes and Dr. Gottula then ended the day with a practice changing summary of the current literature and a new pathway for the management of NSTEMI.

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Annals of B-Pod: Human Trafficking

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Annals of B-Pod: Human Trafficking

Though we may not realize it, human trafficking continues to consume the lives of young women and men throughout the world, including the United States. In this excellent piece, Dr. Jarrell details a presentation of a victim of trafficking to the emergency department and discusses various historical and physical exam findings that should raise a provider’s concern for possible human trafficking.

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