Ultrasound Guided Subclavian Line Pearls

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Ultrasound Guided Subclavian Line Pearls

Subclavian central lines have historically been a landmark based procedure. While for years IJ and femoral central venous access had move to being primarily ultrasound guided (or entirely ultrasound guided), the subclavian line was a long standing holdout. As such, providers may be unfamiliar with some of the pearls that can facilitate performance of the procedure with ultrasound. In this post, Dr. Ben Duncan, ultrasound fellow discusses some of the ways to help make ultrasound work for you while trying to perform a subclavian line.

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Grand Rounds Recap 06.16.21

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Grand Rounds Recap 06.16.21

This week’s Grand Rounds was kicked off by Dr. Fadlalla from Internal Medicine, who described his journey to a career in global health. Dr. Rafferty from Colorectal Surgery discussed anorectal disease in the Emergency Department. Drs. Milligan and Hall expertly led us through the diagnosis and treatment of dyspepsia. CPC featured a case of HUS from Dr. Winslow that Dr. Continenza walked us through. We finished with a review of genitourinary disease by Drs. Gawron, Hassani, Laurence, and Walsh.

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Anatomy of a Procedure - Subclavian Cannulation

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Anatomy of a Procedure - Subclavian Cannulation

The subclavian central line, whether using an infraclavicular or supraclavicular approach can strike fear in the novice proceduralist. Big needles traversing near and seemingly towards a patients lung apex is not exactly a comforting vision. However, like with most procedures, a firm understanding of the anatomy at play will give the operator confidence as they approach what is a critical central venous access procedure particularly in crashing patients.

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Grand Rounds Recap 06.09.21

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Grand Rounds Recap 06.09.21

This week’s Grand Rounds was kicked off with our inaugural “The Art of EM” lecture that included a panel of our esteemed non-UC trained faculty members Drs. Lang, Minges, D.Thompson, Adan, and Stolz. Dr. Gillespie then expertly led us through hand infections in her R1 Clinical Knowledge lecture. Drs. Comiskey & Crawford took us on a deep dive of the literature surrounding the evaluation and management of DVTs. Lastly, our PEM colleagues walked us through a great video-simulation case series on critical pediatric cardiac pathology!

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Dyspepsia in the ED

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Dyspepsia in the ED

Dyspepsia and epigastric pain secondary to gastritis is a common presentation seen in the Emergency Department. Patients with dyspepsia want both quick and sustained relief of their symptoms. A thorough understanding of the evidence behind acute and long-term treatments of dyspepsia is key. In this post, Dr. Justine Milligan outlines the many treatment options available to the ED provider.

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A New Schema for Extraglottic Devices

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A New Schema for Extraglottic Devices

Airway devices abound both in the ED and in the prehospital environment. Over the past few decades the use of extraglottic devices has increased significantly. In this post, Dr. Andrew Cathers recaps a recent article from Annals of Emergency Medicine where the authors sought to categorize these devices by the ways in which they are placed and to then apply that categorization to a cohort of deceased patients to hopefully shed light on the use and failures of these devices.

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Grand Rounds Recap 06.02.21

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Grand Rounds Recap 06.02.21

What a fabulous and jam-packed Grand Rounds it was! Drs. Knight, Roche, and Freiermuth kicked us off with fantastic attending case follow-ups with pearls for physicians of all levels. Drs. Frankenfeld and Hill duked it out in a fascinating case of iron toxicity. Dr. Thompson expertly led us through UC’s new model for patient safety. Dr. Freiermuth brought us back to the basics of refining our history taking skills with tips on approaching sensitive topics. Dr. Pulvino walked us through a very difficult presentation of simultaneous stroke and STEMI in her R3 Taming the SRU. Lastly, Dr. Mand capped off the day with her R4 capstone detailing the lessons she has learned throughout her residency training. Tune in now for a great read!

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Grand Rounds Recap 05.26.2021

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Grand Rounds Recap 05.26.2021

Dr. Koehler reviews cases and shared clinical pearls with this month’s Morbidity and Mortality Conference, Dr. Kowalenko visits virtually to discuss ABEM Board Certification and give us a medical history lesson on Presidential Assassinations

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EKG to Activation - A Quality, Quality Metric?

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EKG to Activation - A Quality, Quality Metric?

Time is myocardium, and minimizing door-to-activation time improves outcomes in patients with acute coronary occlusion. There are a number of existing quality metrics used to help drive improvements in the time-based care of STEMI patients. Could a new quality metric help the decision making time of Emergency Physicians?

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Is a STEMI a STEMI in Post-ROSC Patients?

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Is a STEMI a STEMI in Post-ROSC Patients?

One of the first tests ordered for a patient with ROSC following cardiac arrest is an EKG. Many of these EKGs are profoundly abnormal. Current practice is to evaluate for STEMI and to activate the cardiac cath lab if one is found. But, the test characteristics (sensitivity and specificity) of post-ROSC EKGs are likely different than the test characteristics for patients presenting to the ED with complaints of chest pain/symptoms concerning for ACS. This meta-analysis looked to pull together the existing literature and determine those test characteristics for this critically ill patient population. Read the summary after the link and listen to the podcast to hear a breakdown of this study.

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Grand Rounds Recap 5.5.21

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Grand Rounds Recap 5.5.21

This week’s Grand Rounds started off with a journal club on various aspects of emergent heart catheterization with Drs. Berger, Roblee and Thode. This was followed by some evidence by Dr. Sams on the evidence and feasibility of proning in the prehospital setting. Dr. Knight gave a case-based lesson in neuroimaging and finally Drs. Gleimer, Shaw and Hughes gave a sim on buproprion overdose and a guest lecturer on Human Trafficking.

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