Diagnostics: Musculoskeletal Ultrasound

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Diagnostics: Musculoskeletal Ultrasound

Ultrasound continues to push into more and more of the physical exam, and nowhere is that clearer than in the musculoskeletal exam. From diagnosing and prognosticating patellar tendon ruptures and ligamentous injuries to being a procedural adjunct in shoulder dislocation to critical identification of necrotizing fasciitis, it continues to push boundaries. Dr. Broadstock gives us a look at some of the applications you need to make yourself a better practitioner in this week’s Diagnostics of Musculoskeletal US post.

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Grand Rounds Recap 11.6.19

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Grand Rounds Recap 11.6.19

This week Dr. Irankunda and Dr. Berger took us through their excellent QIKT on strangulation and asphyxiation. Dr. Knight walked us through the initial ventilator management in the ED. Dr. Habib talked about some common mythology and Dr. Makinen lead us through a physiologically challenging airway in a sick trauma patient. Ended with a thrilling R4 sim focusing on altitude illnesses.

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Prehospital Stroke Triage

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Prehospital Stroke Triage

Over the past 5 years, there has been a dramatic expansion of the treatment strategies used to treat patients with acute ischemic stoke. As some of these treatments involve specific resources only available at certain institutions, appropriate triage of patients in the prehospital environment is becoming ever important. On one hand a patient who would best benefit from endovascular treatment triaged to a center without that capability will undoubtedly suffer a delay in care. On the other hand, over-triaging stroke patients to a comprehensive stroke center could overwhelm the resources of that center, potentially impacting the care of patients at that center. In the podcast below, we talk with Dr. Jason McMullan of the UC EM Division of EMS and Dr. James Li, PGY-3 who both have recent publications focusing on this phase of patient care.

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Grand Rounds Recap 10.23.19

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Grand Rounds Recap 10.23.19

This week Dr. Banning discussed several practice-changing topics in our Morbidity and Mortality conference. Drs. Laurence and Wolochatiuk prsented their QIKT project for the management of acute, decompensated pulmonary hypertension, and Dr. Wright gave a fascinating presentation on the approach to fever in a returning traveler.

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Grand Rounds Recap 10.16.19

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Grand Rounds Recap 10.16.19

This week we disccused interventions for the crashing asthma patient with Dr. Mand, ESRD and dialysis related complications with Dr. Scanlon, shoulder and elbow xrays with Drs. Crawford and Scanlon, and a case of intussusception in an adult patient with Drs. Hunt and Bryant. Dr. Gauger provided his case follow up on PJP pneumonia complicated by methemoglobinemia, and Dr. Li took us through the ins-and-outs of gastric lavage in a simulated case of calcium channel blocker overdose.

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Air Care Series: No Lung No Problem - VV ECMO

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Air Care Series: No Lung No Problem - VV ECMO

No Lung? No problem! Join Liz Powell, Paige Barger and Adam Gottula as they take a look at the basics of VV ECMO in the transport environment.

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X-ray Vision - Shoulders and Elbows

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X-ray Vision - Shoulders and Elbows

Upper extremity trauma and pain related complaints are frequently encountered in the Emergency Department. In this post, we cover the basics of the anatomy of the shoulder and elbow joint, the radiographic studies frequently performed in the evaluation of shoulder/elbow injuries, and cover some commonly encountered injuries of these joints.

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Grand Rounds Recap 10.9.19

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Grand Rounds Recap 10.9.19

This week we continued our leadership curriculum with Dr. Pancioli’s lecture on the intersection of leadership and finance. This was followed by Dr. Klaszky with his R4 case follow up of a patient with cardiac tamponade, and then Drs. Baez and Continenza faced off for the most recent installment of our Great Debate series as they discussed chemical vs electrical cardioversion for atrial fibrillation. Finally, our colleagues from Cincinnati Children’s presented learning pearls about causes of and interventions for hypoxia in pediatrics emergency medicine.

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Grand Rounds Recap 10.02.19

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Grand Rounds Recap 10.02.19

In this week’s Grand Rounds we discussed spinal fractures and imaging of knees and hips with our R1s, Drs. Kimmel and Gressick. Dr. Hassani from the R2 class took on Dr. LaFollette with a case of thyrotoxicosis presenting as a-fib with RVR in his CPC, and Dr. Koehler from the R3 Class taught us about heroin/naloxone-induced pulmonary edema. Dr. Golden from the R4 class discussed Fournier’s Gangrene complicated by sepsis-induced cardiomyopathy, and finally our trauma surgery colleague Dr. Pritts discussed some hot topics in trauma.

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Sepsis Journal Club Roundup

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Sepsis Journal Club Roundup

The management of patients with sepsis can be exceptionally complex. As with many patient’s with complex critical illnesses, often times attention to seemingly minor aspects of the patient’s management can have significant impacts on the patient’s course of illness. In this recap of our most recent journal club, we review 3 such aspects of the care of patients with sepsis. Does the type of IV fluids really make a difference? Are steroids a friend or foe in the care of these patients? And can the simple bedside assessment of capillary refill replace serial measurements of lactate?

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Ultrasound of the Month: Lower Uterine Segment Gestation

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Ultrasound of the Month: Lower Uterine Segment Gestation

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.

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Diagnostics: Knee and Ankle X-rays

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Diagnostics: Knee and Ankle X-rays

Hip 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

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Grand Rounds Recap 9.25.19

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Grand Rounds Recap 9.25.19

This 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!

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Mastering Minor Care: Ankle Arthrocentesis

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Mastering Minor Care: Ankle Arthrocentesis

Far 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.

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Falling Out - Syncope Evaluation in the Emergency Department

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Falling Out - Syncope Evaluation in the Emergency Department

Syncope 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? 

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