This week’s Levy Cup, a time honored yearly show of knowledge, skill and improvisation of the UC EM Residency. Although online, our R4 team threw together a great show of pictionary, telemedicine and with some well deserved victors.
Read MoreGrand Rounds this week started with airway QI and COVID-19 airway management per the consummate expertise of Dr. Carleton. Dr. Mullen then taught the pearls and pitfalls of urine drug screens, Dr. Paulsen arose victorious from CPC vs. Dr. Wolochatiuk, and Dr. Ijaz gave a stellar review of ear pathology in the ED. Finally, Drs. Golden, Ham, and Spigner took us on a tour de force remote simulation of structural collapse with crush syndrome complicated by hyperkalemic arrest.
Read MoreTransport of the ARDS patient is fraught with risk. These patients are at high risk of decompensation, which can be disastrous in the back of an ambulance or helicopter. The primary goal for critical care transport teams should be safe arrival of both the crew and patient to their destination. As such, if patients are achieving an adequate oxygen saturation at the referring facility, the better part of valor is to continue the current course, even if ventilator settings are suboptimal. If ventilator changes need to be made due to inadequate oxygenation, ventilation, or other factors, strong consideration should be given to LPV settings. Review the management literature behind ARDS management in 2020 with Chris Shaw, MD.
Read MoreThe urine drug screen (UDS) is a relatively inexpensive and quick test to obtain in the emergency department, but how useful is it?. You may be tempted to order it for a patient who comes in altered or intoxicated. Before ordering, it is important to understand how the UDS works and its limitations.
Read MoreAnother fantastic week of video conferencing started with Dr. Ham’s Morbidity and Mortality presentation through an array of zebras seen in our ED, Dr Ramsey discussed ED use of ocular ultrasound, Drs Adan and Connelly faced off in CPC case of retroviral syndrome and Dr Harty’s capstone detailed cases of pediatric patients which will prep any new parent.
Read MoreThis month, the Taming the SRU ultrasound team details some of the procedural applications of ultrasound in the midst of the COVID-19 pandemic, fresh from two of the minds our intern class: Drs. Hamza Ijaz and Chris Zaleky. This combo post will discuss the use of ultrasound to confirm placement of both endotracheal tubes and central venous catheters.
Read MoreOcular Ultrasound is an increasing presence in the portfolio of specific tests within the Emergency Physicians’s toolbox of early recognition of pathology. Dr. Logan Ramsey takes a dives into the indications and evidence of ocular ultrasound
Read MoreAnother great week of Grand Rounds started with a journal club on pediatric resuscitation (podcast inbound soon), followed by a new electrolyte protocol via QI/KT with Drs Gawron and Hassani. Dr. Jensen’s TamingtheSRU lecture highlights a complex combination drug overdose and Dr. Garber gives an update on the pharamcotherapies of COVID. Finally Drs. Leech and Hill trialed the first remote simulation on post partum hemorrhage.
Read MoreHow often do we see the elderly patient that comes into the ED with the chief complaint of “nosebleed”? Although these visits are usually straightforward, sometimes they are not. Be prepared for the next complicated nosebleed you see by reading this post by Dr. Ijaz who nose a thing or two about epistaxis!
Read MoreWe had another exemplary installment of Grand Rounds this week that started with Attending Case Followup with Drs. Lang, Baez, and Paulsen. Then we had some top-notch review of core curriculum with Dr. Winslow and the Alvarado Score for appendicitis, Drs. Meigh and Klaszky on food impactions and esophageal foreign bodies, and Drs. Comiskey and Nagle on D-dimer. Finally, Dr. Nagle gave us an overview of the foundations of evidence-based medicine with his R4 capstone.
Read MoreAppendicitis is the most common surgical emergency that emergency physicians encounter each year. The prevalence of appendicitis in the US is estimated at 7%, with an incidence of 9.38 per 10,000 people annually [1,2]. Appendicitis shares many signs, symptoms, and laboratory features with other acute medical and surgical conditions, including diverticulitis, nephrolithiasis, and ovarian pathologies like tubo-ovarian abscess and ovarian torsion. Diagnostic tools such as the Alvarado score are designed to help emergency clinicians sharpen their diagnostic acumen by stratifying the likelihood of appendicitis based on scoring systems
Read MoreThis week there were a number of underlying themes between pacemakers, MIs and leadership as well as some other high yield topics sprinkled in. Dr. Broadstock kicked us off with an educational lecture on pacemakers. We combined with our neurology colleagues to discuss how to best take care of basic neuro complaints in the ED in the time of COVID. R3s led an awesome small group on high sensitivity troponin. Dr. Banning shared the lessons she has learned through her own mistakes and failures. A truly heroic resuscitation for a patient in R heart failure by Dr. Skrobut in his Taming the SRU lecture. Lastly, learned about pediatric ophthalmology from Dr. Zamor.
Read MorePediatric cardiac arrests are, potentially, some of the most challenging patients for an emergency physician to care for. Cognitively, emotionally; these patients push us to our very limits. In this journal club recap, we cover 3 recently published articles looking at the care of these patients. Should survivors be cooled? Is Epi any good? Which is better amiodarone or lidocaine?
Read MoreIn times of COVID, a Dimer of 3000 is nothing to look twice about, however there was an earlier (and future) time where the D Dimer is the hallmark of pulmonary embolism risk stratification. Dr. Comiskey breaks how how this once dichotomous tool has recent data to increase its specificity in elderly patients, pregnant patients and those with low pretest risk factors. Take a look, and when this whole pandemic is over your quiver will be fuller of Dimer tips.
Read MoreAs we continue our teleconferenced grand rounds, we started with a timely review of ARDS management and refractory hypoxemia with Dr. Shaw, two successful faculty guessed CPCs presented by Drs Irankunda and Pulvino and finally Dr. Jarrell gave us a much needed break with a baking show from her kitchen, with an included recipe for a mug cake!
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.
