Twists and Turns: Identifying Maisonneuve Fractures in the ED

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Twists and Turns: Identifying Maisonneuve Fractures in the ED

A Maisonneuve fracture is a specific ankle fracture pattern that involves the medial malleolus, syndesmosis and proximal fibula. It can be easily missed if a provider does not routinely evaluate the proximal fibula as part of their ankle examination, as x-rays of the ankle can often appear normal. Disruption of these structures yields an unstable ankle fracture, thus making close follow up for operative management imperative. It is key to identify this fracture when patients present to the Emergency Department with ankle injuries to ensure definitive management and prevention of complications down the line. 

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Grand Rounds Recap 9.20.23

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Grand Rounds Recap 9.20.23

Another excellent week for UCEM Grand Rounds! We started the day with an introduction to universal HCV screening in the ED from our pharmacy colleagues. We then transitioned to a great discussion on concussions sports medicine faculty Dr. Gawron. Next, Dr. Guillaume led us through diagnostics and therapeutics for nonconvulsive status epilepticus. Then, Dr. Shaw presented two cases of PRES and the importance of recognizing this diagnosis. Finally, R4s led the way through a simulation on adrenal insufficiency as well as structured oral boards case practice.

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Has Video Finally Killed DL?

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Has Video Finally Killed DL?

More than 1.5 million adults undergo tracheal intubation outside of the operating room each year in the United States. Traditionally, this has been performed with direct laryngoscopy, where a clinician displaces the patient’s tongue and epiglottis with a laryngoscope blade to visualize the vocal cords through the mouth, allowing for direct visualization of the passage of an endotracheal tube. An alternative method for tracheal intubation is video laryngoscopy, where a camera on the distal half of the blade transmits an image to a screen allowing for indirect visualization of the vocal cords and passage of an endotracheal tube without direct line of site.

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Induction Reduction?

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Induction Reduction?

Rapid sequence intubation (RSI) is frequently performed under emergent conditions in acutely ill patients. RSI is a technique for managing the emergency airway that induces immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent). In properly selected patients, it is a quick, safe, and effective approach that results in optimal intubating conditions. However, one of the feared complications of RSI is post-intubation hypotension leading to cardiovascular collapse. Although there are multiple possible reasons for hypotension post-intubation, the choice and dosing of induction agents has been implicated.

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Grand Rounds Recap 9.13.23

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Grand Rounds Recap 9.13.23

Join us to recap another week of UCEM Grand Rounds! We start with a quick hits EKG lecture with Dr. Baez, focusing on common EKG findings associated with electrolyte abnormalities. Dr. Tillotson teaches us how to set up inhaled therapies for our critically-ill patients, while thousands of feet in the air! We then turn to Dr. Chang and learn how to expertly treat pain and perform procedural sedation on the smallest of patients we encounter as emergency physicians.

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Grand Rounds Recap 9.6.23

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Grand Rounds Recap 9.6.23

Join us for a review of another fantastic week of Grand Rounds. We start with Dr. Minges expertly guiding us through performing DVT studies in the ED, to help us better address the needs of the patients in front of us. Dr. Kreitzer presents the data, as well as and personal experience, to passionately advocate for including family members in the ED and ICU’s- including procedures, resuscitation, rounds, and multidisciplinary meetings. Meanwhile, Dr. Onuzuruike refreshes our foundation knowledge pertaining to AICD’s in the ED. Lastly, Drs. Negron and Wright reflect on their expertise as leaders in the SRU to teach us all about managing the most difficult airways- including intubating through the nose and even an supraglottic device.

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Grand Rounds Recap 8.16.23

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Grand Rounds Recap 8.16.23

Join us to summarize another fantastic series of Grand Rounds lectures. We start off with in-flight emergencies, including changes to physiology and what equipment is available to you on most commercial flights, with Dr. Urbanowicz. Followed by a literature-filled debate between Drs. Lane and McDonough on the utility of CT pan-scans in trauma patients. With the help of Dr. Shewakramani, we all learn how to better recognize and care for patients with sepsis. Meanwhile, Dr. Roche teaches us about all various bites/stings- including marine species, scorpions, and mosquitos! Lastly, Dr. Wright introduces us to the science of reliability and how to design processes in healthcare to be more reliable, with the ultimate goal of improving our care of patients.

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Grand Rounds Recap 8.30.23

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Grand Rounds Recap 8.30.23

We start off strong this week with EMS grand rounds, where EMS fellow Dr. Klein walks us through potential uses and barriers for using ultrasound in the prehospital setting. We then moved on to our R1 Diagnostic and Therapeutics lecture, where Dr. Segev expertly led us through a discussion on the use of inflammatory markers in the ED including several small group cases. Next, an exciting CPC matchup between Drs. Schor and Stolz who went head to head to discuss a mysterious case of the hiccups. This was followed by Dr. Diaz who gave her R4 Capstone lecture on what her R4s taught her. Finally, we wrapped up the day with an excellent discussion on airway management during our airway grand rounds.

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Grand Rounds Recap 8.9.23

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Grand Rounds Recap 8.9.23

Join us as we recap our last week of Grand Rounds, including our first intern lecture of the year focusing on pericarditis & myocarditis. Learn about the art of skillfully resuscitating a patient with an LVAD, as well as the tips/tricks for effectively communicating with patients, from our senior residents. Learn how to confidently handle ENT emergencies in the community and orthopedic trauma in a limited-resource settings. Our pharmacy colleagues gave us an timely update on use of Precedex in the ED, as well as Andexxa vs. PCC for reversal of Xa-inhibitors. Lastly, our pediatric EM colleagues joined us to discuss to subtle difference in diagnosis and management of neonatal & pediatric seizures compared to adults.

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Grand Rounds Recap 8.23.23

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Grand Rounds Recap 8.23.23

We start out this week with our Morbidity and Mortality conference with Dr. Stark where she dives into a variety of cases included dog bite related infections, critical care boarding, malaria, septic bursitis, lunate dislocations, and regional wall motion abnormalities. Next, Drs. Arnold and Wilson discuss workup and management of patients with acute liver failure in the emergency department. Dr. Moulds then followed where she discussed ventricular tachycardias including Torsades de Pointes during her Taming the SRU presentation. Finally, we wrapped up the day with Dr. Kein’s R4 Case Follow Up where she discussed a patient who presented three patient cases who deserve your conservativism.

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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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