This week featured an all-start lineup of resident lectures. Dr. Golden started us off with an amazing M&M, followed by Dr. Mullen enlightening us on eating disorders and the management in the ED. Dr. Iparraguirre taught us about the management of the severely burned patient. Dr. Laurence and Dr. Lagasse faced off in another interesting CPC. Finally Dr. Goff, hit it home with review of pneumonia severity scores and their clinical context.
Read MoreNormal saline has taken hold as the de facto resuscitative fluid in the majority of health care institutions in the developed world. Walk through the recent data with Dr. Christopher Shaw which suggests that balanced fluids may provide benefit to patients suffering from a wide array of critical illnesses.
Read MoreAccording to the American Thoracic Society (ATS) in 2018, 1 million patients required hospitalization for pneumonia and there were 50,000 associated deaths. Pneumonia was the leading cause of sepsis and septic shock and not surprisingly therefore qualified in the top 10 most expensive inpatient hospitalizations.(1) Given these findings, some have sought opportunity to develop mechanisms to assess and safely triage pneumonia patients to either inpatient or outpatient treatment strategies based upon pneumonia severity scores. In October 2019, the Infectious Diseases Society of America (IDSA) in conjunction with the ATS published recommendations for the assessment, treatment and disposition of immunocompetent adult patients with community acquired pneumonia which included several clinical decision rules also known as pneumonia severity scores.(2) The recommended decision rules and several associated, emerging tools are reviewed here.
Read MoreDr. McDonough and Dr. Palmer kicked off this week with an engaging session of leadership curriculum discussing self-promotion as well as how to write an effective CV. Dr. Forde walked us through the exciting topic of Mobile Stroke Units during EMS Grand Rounds. Lastly, Dr. Krack walked us through some interesting and terrifying pediatric heme-one emergencies.
Read MoreThis week in grand rounds we had an excellent discussion on leadership and how emergency medicine can impact the future of medicine by visiting lecturer, Dr. Andra Blomkalns current chair at Stanford University and UC alumni. Dr. Golden enlightened us on diabetes technology so we can better take care of our diabetic patients with insulin pumps and continuous glucose monitoring.
Read MoreIntrathecal baclofen withdrawal is characterized by increased spasticity, hypertension, tachycardia, hyperthermia, altered mental status, and seizures. In the most severe cases, autonomic instability, rhabdomyolysis, diffuse intravascular coagulopathy, multisystem organ failure, and death can occur. In this episode of the research corner, we cover a recently published case report where intrathecal baclofen withdrawal was treated successfully with dexmedetomidine.
Read MoreThis week we had another great M&M where Dr. Klaszky covered exciting topics such as refractory V fib, hypothermia and cerebral malaria. We learned about misnomers, mimics and lies about TB from Dr. Owens. Dr. Zalesky skillfully walked us through a simplified approach to reading brain MRIs. Lastly, Dr. Leech and Dr. Goel faced off in a CPC involving a patient with ALS.
Read MoreWe are all familiar with the “lethal triad” of trauma – coagulopathy, hypothermia, and acidosis. We have multiple methods wherein we attempt to prevent or reverse these physiologic derangements. In particular, in recent years many teams have focused heavily on limited crystalloid infusions, increasing our early blood product transfusion (especially plasma), and early administration of tranexamic acid.
One of the main reasons we focus on these interventions is to address trauma-induced coagulopathy. Trauma-induced coagulopathy has a multifactorial etiology and is contributed to by the other corners of the triad (hypothermia and acidosis). However, one of the least appreciated contributing factors are electrolyte deficiencies, in particular calcium.
Read MoreIf you have ever nodded along as someone described an MRI series weighting, you are not alone. As this modality becomes more accessible to the Emergency Physician, it is incumbent on us to familiarize ourselves with the critical aspects and critical diagnoses of MRI and how to speak the language. Dr. Zalesky takes us on a tour of the physics, indications and low-down of MRI from the ED.
Read MoreDr. Mand brings Ultrasound Case of the Month into the new decade with a thorough discussion of echocardiographic evaluation of patients with suspected acute coronary syndrome (ACS) in the emergency department, including limitations, correlation with other established diagnostic modalities, and a review of the existing evidence.
Read MoreWe had another great week in Grand Rounds, starting with a QI/KT presentation from Drs. Hunt and Pulvino about Tumor Lysis Syndrome. Next, Dr. Meigh gave a great presentation about TORCH infections and Dr. Spigner gave his R4 Capstone lecture on pre-hospital sepsis care. We welcomed a guest speaker, Dr. Henning, from podiatry who discussed a number podiatry emergencies. Finally, the week wrapped up with a simulation of an inferior STEMI in trauma.
Read MoreThis week we brought in the new Roaring 20s with an exciting lineup. Drs. Gauger, Humphries, Jarrell, and Owens led us through a simulated case of hypertensive emergency in a cocaine body packer. Dr. Gressick taught us about blunt carotid artery injuries, and Dr. Gottula discussed resuscitation of septic patients with comorbid CHF and ESRD. Dr. Ham took a detour from clinical topics to discuss how to go about finding your niche in medicine, and Dr. Doerning increased our financial literacy with his high-yield points. Finally, our colleagues from Cincinnati Children’s helped us learn the nuances of having difficult conversations with children and their families.
Read MoreThe treatment of Acute Ischemic Stroke is a rapidly evolving field with critical care transport medicine playing an increasing role in the treatment of these patients. Dr. Irankunda explores CCTM specific management and historical musts when treating this unique patient population. Dr. Gottula provides a brief review of the literature supporting IV alteplase and endovascular thrombectomy.
Read MoreDr. Ham led off this week’s Grand Rounds reviewing cases from the month of November for our monthly Morbidity and Mortality conference. Dr. Chuko then led us through a deep dive on the diagnosis and treatment of male genitourinary disorders and was followed by Dr. Frankenfeld who led our small group discussion on STEMI equivalents. A battle of minds ensued between Dr. Gawron and Dr. Betz of an interesting case of traumatic rhabdomyolysis. Finally, Dr. Crook reviewed all of the latest important changes to the southwest Ohio EMS protocol.
Read MoreThe 2013 ACC/AHA STEMI guidelines outline, with specific age and gender-related cutoffs for ST segment elevation in certain leads. While these are clinically important, there are several STEMI equivalents or EKG patterns that do not meet these criteria but should point the practitioner to consult with an interventional cardiologist. These STEMI equivalents are found in 10-25% of cases of coronary occlusion, making it imperative that emergency personnel be familiar with these patterns.
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.
