Grand Rounds Recap 8.2.23

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Grand Rounds Recap 8.2.23

We had a jam packed grand rounds this week, which was started off strong by Dr. Knight taking us through identifying sick vs. not sick patients. Drs. Della Porta and Kimmel then battled it out in this years first CPC. Next we were taken through acute ischemic stroke updates with the stroke team duo Drs. Demel and Kreitzer, followed by a quick hit lecture on AV blocks for the EM physician by Dr. Lang. We finished off the day with our R4 capstone reviewing over-testing in the ED with Dr. Yates followed by a review of what data to trust with Dr. Freiermuth and Sucharew for Research Grand Rounds.

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Grand Rounds Recap 7.26.23

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Grand Rounds Recap 7.26.23

This week we started off strong with the first Morbidity and Mortality of the academic year presented by Dr. Kletsel. This was followed by Dr. Smith’s R4 Case Follow up on the unique pathology of an LV thrombus. Dr. Jackson then takes us through methods for Taming the SRU and subarachnoid hemorrhages. Finally, we wrapped up with case-based discussions on opioid use disorder in the emergency department.

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Grand Rounds Recap 7.19.23

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Grand Rounds Recap 7.19.23

Join us for another week of GR! We started off strong with social emergency medicine updates from our active department and the many ways they can help us better help our patients. We moved into alcohol use disorder treatment with Dr. Ryan detailing medical management for abstinence that can be started in the ED. We moved into a trip down memory lane with Dr. Baez and 10 cases that haunt her with the lessons she has learned along the way. Dr. Baxter gave us his thoughts on evaluating patients using clinical gestalt vs clinical decision rules. We moved into neuroimaging with our expert critical care/emergency medicine attending Dr. Knight and some cases with interesting CT/MRI findings. Finally, we wrapped up with oral boards detailing 2 sick patients: one with aspiration pneumonia developing ARDS and one with neuroleptic malignant syndrome. See you all next week!

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Grand Rounds Recap 7.12.23

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Grand Rounds Recap 7.12.23

Another exciting week of grand rounds with a ton of variety! We started off with Fundamentals of ECMO with Dr. Bonomo, one of our EM/CC faculty, so that we have a better understanding of why and how ECMO works and the data surrounding outcomes, as well as how to facilitate identifying appropriate candidates to allow for cannulation directly from the ED for E-CPR or VV-ECMO. Next, Dr. McDonough helped us practice leading as a listener with a lecture and small groups for this iteration of our longitudinal Leadership Curriculum. We moved into ultrasound GR with Dr. Stolz and discussed many different types of artifact and their clinical utility in our point-of-care practice. We closed out with Macgyver techniques with Dr. Ham and learned his tips and tricks to rocking central lines!

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Grand Rounds Recap 6.28.23

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Grand Rounds Recap 6.28.23

For our first grand rounds of the academic year, Dr. Paulsen challenged us with her Admit/Discharge/Transfer lecture which made us ponder the disposition of several difficult cases. This was followed by a case-based and interactive discussion on how to break bad news to patients in the ED by Dr. McDonough. Last but not certainly not least, our Department Chair Dr. Pancioli took us through the past, present, and future of EM, it’s triumphs, and potential threats to the way we practice.

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Hunting for Invasive Bacterial Illness in Infants with a Positive UA

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Hunting for Invasive Bacterial Illness in Infants with a Positive UA

The workup of febrile infants (<60 days) can be extensive and invasive. This post and podcast covers a recent paper by the PECARN research group that sought an answer to the question: What is the prevalence of bacteremia and/or bacterial meningitis (“invasive bacterial illness”, ISI) in febrile infants ≤60 days of age with a positive urinalysis (UA) result?

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Riding the Waves: End-Tidal CO2 Monitoring

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Riding the Waves: End-Tidal CO2 Monitoring

End-Tidal CO2 monitoring has a variety of uses in the Emergency Department.  Whether used diagnostically or for monitoring of a patient’s physiology, clinicians must possess an understanding of the information that you can gather from EtCO2 waveform tracings. Knowing how to interpret the waveforms makes EtCO2 much more than a number, allowing the clinician to gain insight into minute to minute changes in a patients physiological state.

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Grand Rounds Recap 6.21.23

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Grand Rounds Recap 6.21.23

This week’s grand rounds starts off strong with the last Morbidity and Mortality of the year presented by Dr. Zalesky. This included multiple stimulating cases including meningitis, procedural safety, acute aortic syndromes, hemophilia, electrical storm, and euglycemic DKA. Finally, we wrap up the day with a lecture on the science behind wellness with Dr. Martella.

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Grand Rounds Recap 6.7.23

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Grand Rounds Recap 6.7.23

This week Dr. Diaz starts off with a challenging case of massive upper GI bleed managed with balloon tamponade. We then moved into a case follow-up with profound electrical storm and recurrent ventricular arrhythmias secondary to a STEMI. Following this, we took a deep dive into waveform capnography regarding normal physiology and alterations with lung pathology with Dr. Wilson. Next, we had an exciting CPC showdown where Dr. Bryant successfully diagnosed Dr. Haffner’s case of valproic acid toxicity presenting with hyperammonemic encephalopathy. We closed with Dr. Wosiski-Kuhn outlining the difficulty of intubation in a patient with DKA and severe metabolic acidosis.

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EtCO2 vs. Standard Triage Vitals in Predicting In-Hospital Mortality and ICU Admission

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EtCO2 vs. Standard Triage Vitals in Predicting In-Hospital Mortality and ICU Admission

Boarding of admitted patients in the ED and subsequent overcrowding of ED’s continues to plague hospitals in the United States and Internationally.  The Covid-19 pandemic exacerbated an already growing problem regarding capacity management and patient flow. In this current climate, the Emergency Physician’s responsibilities continue to shift toward the front-end of the process, mainly patients waiting to be seen in the lobby.  As such, identifying sick patients in a timely manner and utilizing additional resources to predict patients at risk of clinical deterioration will be paramount moving forward.

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