Characterizing location of an intrauterine pregnancy is a key portion of the sonographic exam in early gestation. In this month’s case Dr. Leech describes a case concerning for lower uterine gestation, as well as the diagnostic and therapeutic considerations for this pathology.
Read MoreHip and knee pain almost categorically get an X-Ray in the ED, but when do you need more? And when could another view help you avoid a more costly imaging test? This week join Dr. Gressick as she gets back to the basics in the acquisition and interpretation of the hip and knee X-Rays
Read MoreThis week Dr. Klaszky started us off with a great M&M of reviewing tPA and sumitriptan indications, EMTALA background and more. Dr. Chuko led a small group discussion of syncope rules based on his post from earlier in the week, Dr. Roblee tried to stump a faculty during her CPC of a syphilis case. Check it all out in this week’s GR Recap!
Read MoreFar too often we are faced with the situation in which we are concerned about septic arthritis in a patient’s ankle. Although tapping the ankle can be a daunting task, Dr. Leech provides us with a guide in this month’s minor care post to make difficulty with ankle arthrocentesis a problem of the past.
Read MoreSyncope is a common presenting complaint to the emergency department. Estimates suggest that 1- 3 percent of ED visits are for syncope.(1) While the large majority of these episodes are often benign, they can suggest underlying life-threatening etiologies such as arrhythmias, pulmonary embolism, and stroke. The disposition of these patients can represent a difficult quandary at times. In fact, emergency physicians are only able to establish a clear underlying diagnosis in approximately 50% of syncope patients after obtaining an HPI, physical exam and ECG. (2)
Should these patients be observed in the ED? And, if so, for how long? Should they be admitted to the hospital for further workup and observation? Should they instead be discharged home with close follow-up?
Read MoreThis was a great week of Grand Rounds with a number of interdisciplinary presentations. The week started off with Dr. Neel presenting about common neurologic complaints in the ED in our first EM-Neurology combined lecture for the year. Dr. Jarrell then presented her R4 Case Follow Up lecture on a case of blunt pancreatic injury in non-accidental trauma. Dr. Wyrick, from the Department of Orthopedics, talked about his experiences on his global health trip to Tanzania. Finally, the week wrapped up with Drs. Iparraguirre, Jensen, and Lane leading small group workshops on orthopedic injuries.
Read MoreTrauma scene flights are often the first thing people think of when they think of Helicopter EMS. Although we know that HEMS and Critical Care Transport involves much more than just scene flights, they are still a critical part of most HEMS programs’ mission and capabilities. In addition, many flights are “modified scenes” or “scene intercepts,” meaning the HEMS crew meets the EMS crew at an outlying hospital helipad, or arrives shortly after the patient’s arrival to an under-resourced ED. Many of these patients are critically ill, and a subset will require intubation and ventilation. Once intubated is bag valve ventilation enough? Or should all these patient’s be placed on a mechanical ventilator?
Read MoreWhile high-quality CPR delivers the best outcomes in cardiac arrest, this is challenging in a transport environment. Dr. Connelly reviews the evidence behind mechanical chest compression in CPR, exploring its practicality to the Helicopter EMS (HEMS) environment.
Read MoreDrs. Winslow and Habib started the Grand Rounds off with a case-based discussion on the Centor Criteria and testing for strep pharyngitis. Drs. Walsh and Sabedra led an interesting discussion about a case of TTP. In his R4 Case Follow Up lecture, Dr. Nagle presented about DKA and family presence during resuscitation. Dr. Hogan, one of the EMS Fellows, gave a great presentation about the current controversies in cardiac arrest management. Finally, the week wrapped up with some great simulation and cases from our PEM fellows about post T&A bleeds, PTA, and acute chest syndrome.
Read MoreMedication Assisted Therapy or MAT is a critical component of the care and treatment of patients with opiate use disorder. Over the course of the past several years, more and more ED providers, have been on the front line of initiating treatment of patients withdrawal symptoms and linking those patients to outpatient resources. In this post, we review the initiation of Buprenorphine based treatment for opiate use disorder in the ED.
Read MoreStrep pharyngitis, commonly known as “strep throat” is a bacterial infection of the oropharynx caused by group A beta hemolytic streptococci (GAS), specifically S. pyogenes. This infection affects more than 500,000,000 people annually worldwide per year, ultimately resulting in a significant number of doctor’s visits, including to the ED (1). The classic clinical presentation of GAS pharyngitis includes sudden onset of sore throat, fever, and odynophagia. If untreated, complications of GAS pharyngitis include scarlet fever, rheumatic heart disease, post-streptococcal glomerulonephritis and peri-tonsillar abscess. In this post, we explore the diagnostic evaluation of pharyngitis with special attention to the use of the Centor criteria and rapid antigen testing.
Read MoreThis week in grand rounds we discussed all types of critically ill patients, first covering the spectrums of hypothermia and shock. We then had a fascinating case follow up on a patient who developed torsades des pointes, and learned how to perform the HINTS exam and incorporate it into our practice. We then discussed pediatric osteomyelitis and it’s subtle presentation, and finally covered musculoskeletal ultrasound of the shoulder, knee, and ankle.
Read MoreOcular ultrasound can be an invaluable tool in the patient presenting with acute vision loss. Dr. Koehler details the diagnostic utility of ocular sonography in this month’s case of unilateral atraumatic vision loss in the ED.
Read MoreDizziness is common and is commonly a frustrating diagnostic dilemma in the ED. As patient’s stories vary between providers, it would be nice if we had a tool that was objective, reproducible and definitive. Enter - the HINTS exam. Join Dr. Ijaz as he discusses this nuanced exam that can change dizziness into a definitive diagnosis.
Read MoreThis week started with a great Morbidity and Mortality Conference with Dr. Ham. Drs. Li, Makinen, Mand, and Skrobut then led small group workshops on HEENT emergencies. Following this, Dr. Harty led a fascinating discussion about a patient with Carotid Blowout Syndrome and Dr. Lagasse presented some of her work on trauma care and prevention from a Global Health perspective. The week wrapped up with Dr. LaFollette discussing arthrocentesis and joint loading in the emergency department.
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.
