As an EM physician, it is important to have an understanding of the spectrum of foot injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive. Injuries discussed are shown in Image 1.
Read MoreAs an EM physician, it is important to have an understanding of the spectrum of ankle injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive.
Read MoreSepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. One of the primary pathophysiologic mechanisms involves complex cascade of host dysregulation in response to an infectious stimulus (Evans, Rhodes et al. 2021, Jarczak, Kluge et al. 2021). Recent meta-analyses and systematic reviews evaluating mortality in patients with septic shock reported mortality as high as 35% and 38% at 30 and 90 days, respectively (Vincent, Jones et al. 2019, Bauer, Gerlach et al. 2020). Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. 2022), ideally with antibiotics administered within one hour of sepsis recognition by the treating provider (Evans, Rhodes et al. 2021). Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al. 2022).
Read MoreEver have that critical pneumonia ARDS patient that just cannot be safely transported without a temporizing (or longer) fix? Join Dr. Ferreri on a case study and deep dive into the physiology behind Epoprostenol use in Transport Medicine.
Read MoreThis week we start off with Drs Davis and Paulsen in a CPC of an infected thyroglossal duct cyst. We then had two tox presentations on ethylene glycol poisoning as well as a trip through all those poisonous plants you knew once. Drs. Zalesky and Wosiski-Kuhn then take a trip around the latest research in EM!
Read MoreOften when we see elevated temperatures in the emergency department, our first instinct is to search for an infectious source. However, when body temperatures start exceeding 40.5 degrees, infection is a less likely etiology and there are a plethora of conditions that need to be considered.
Read MoreThe management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction. The presence of HFrEF limits pharmacologic options for rate control. This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure
Read MoreSpring has sprung... and so have many species of toxic plants! Poison centers across the United States receive over 100,000 reports of exposures to toxic plants annually. It is often difficult for Emergency Medicine providers to determine the quantity and time of exposure. Plant identification presents another challenge, and can even require the input of a botanist. Now that is an interesting consult! Thankfully, some of the more common and/or dangerous plant poisonings have been well-categorized, and are summarized in this post.
Read MoreThis week we start off with Dr. Mullen’s lessons from morbidity and mortality conference. This is followed by R1 Dr. Vaishnav with a diagnostics talk on hyperthermia. Dr. Adan walks us through the always terrifying world of laryngectomy patients and finally guest lecturer Dr. Ray Bignall gives an excellent talk on disparities in medicine and how we address them
Read MoreUnfortunately, we are all familiar with the dangerous respiratory depression that can occur in opioid overdose; but did you know that opioids can also cause hearing loss? Dr. Kein takes us through two cases of opioid overdoses with associated hearing loss, as seen in B Pod.
Read MoreThis is not your average hydronephrosis… Join Dr. Olivia Gobble as she explores the sonographic and physiologic challenges presented by a horseshoe kidney.
Read MoreWe are back with an excellent grand rounds session, where we heard about a case of resuscitative hysterotomy from Dr. Stark, BRASH syndrome, and HIV screening in the ED. We also heard some life lessons from the Peace Corps and how they relate to emergency medicine.
Read MoreWhat 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 MoreEarly 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 MoreWe 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 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.
