Grand Rounds Recap 3.15.23

/
Grand Rounds Recap 3.15.23

What a packed week! We reviewed a harrowing case of massive bee envenomation (with insects in the airway) w/ Dr. Yates, R4 wisdom and philosophies with Dr. Mullen, an overview of hydrocephalus with Dr. Stothers, a CPC of a brain tumor presenting with aphasia with Dr. Glenn, a dive into hyperviscosity syndromes with Dr. Beyde, and a wonderful series of lectures on the Language of Being Well & Embracing Fear in EM with visiting professor Dr. Arlene Chung.

Read More

Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

/
Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.

Read More

Grand Rounds Recap 3.8.23

/
Grand Rounds Recap 3.8.23

We are back with a special grand rounds with visiting professor Dr. Arun Nagdev discussing a variety of ultrasound guided nerve blocks in the ED, CPC with Drs. Harward and Roche, and a review of multiple etiologies and management of pediatric seizure with our CCHMC PEM colleagues.

Read More

Grand Rounds Recap 2.15.23

/
Grand Rounds Recap 2.15.23

Check out this week’s MASSIVE recap with Dr. Connelly’s poignant lessons from her time with Sydney HEMS, Dr. Broadstock’s R4 case follow up of HIV myositis, Dr. De Castro’s extensive Vitamin deficient review, Small Groups on task saturation and ITE review and a Palliative Medicine lecture by dual trained Dr. Kiser.

Read More

Grand Rounds Recap 2.1.23

/
Grand Rounds Recap 2.1.23

This week in Grand rounds, we had some case reflection from R4 Dr.Zalesky reminding us to avoid anchoring, be aware of our biases for or against patients, and avoid creating a rude work environment. Dr. Moulds and Dr. Goel had a CPC showdown with a case of Cecal Diverticulitis, while Dr. Artiga gave us the low down on Lung Ultrasound in the ED. We wrapped up the day with an R4 lead simulation on a case of Thyrotoxicosis.

Read More

Grand Rounds Recap 2.8.23

/
Grand Rounds Recap 2.8.23

During Grand Rounds this week, we had the pleasure of hosting our Brian Gibler visiting lecturer Dr. John Deleda who Spoke about Henry Ford Hospitals COVID-19 response and the leadership lessons he learned over his career. Dr. Della Porta then gave us the rundown on different blood products and using TEG. We discussed PPROM, Breech delivery, and neonatal resuscitation with Dr. Crawford. The CPC showdown with Dr. Minges and Dr. Brower ended as a case of Hyperleukocystosis and Leukostasis. We ended the day with a talk from our PEM colleagues on inborn errors of metabolism.

Read More

CTs for SAH - Does Time Even Matter?

/
CTs for SAH - Does Time Even Matter?

Spontaneous subarachnoid hemorrhage (SAH) is a can’t miss diagnosis for patients presenting to the emergency department with a headache. The diagnosis is associated with a 30% mortality at 30 days, and approximately 30% of survivors may have long-term neurocognitive deficits (Rincon et al., 2013). The majority of spontaneous SAH are secondary to a ruptured arterial aneurysm (80%) while non-aneurysmal SAH are often due to low pressure venous bleeds, arteriovenous malformations, and other more rare causes. This post will recap the existing literature on the diagnosis of aSAH and will focus on breaking down a recently published paper by Vincent, et al which may inform our future practice.

Read More

Caustic Skin Injuries

/
Caustic Skin Injuries

Chemical burns are also an evolving pathology, with thousands of new chemicals added to the market each year (4). Since 2000, both assault and warfare with chemical weapons have increased, although these pathologies vary based on practice location (1). For instance, chemical burns can comprise up to 14% of burns in the developing world, compared to 3% in the US and Europe (2, 5). It is therefore important to understand your local chemical burn patterns, in much the same way providers learn local patterns of antibiotic resistance.

Read More

Grand Rounds Recap 12.21.22

/
Grand Rounds Recap 12.21.22

This week, we reviewed some ENT pearls, discussed the differential diagnosis of bilateral upper extremity weakness in a fantastic CPC case, discussed paraneoplastic syndromes, and held a hands on airway workshop.

Read More