Serratus Anterior Plane Blocks for Rib Fractures in the ED

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Serratus Anterior Plane Blocks for Rib Fractures in the ED

Rib fractures occur in up to 10% of all traumatically injured patients and these fractures are frequently associated with respiratory complications such a pneumonia. In the ED, our typical protocol to decrease the incidence of these respiratory complications is early initiation of aggressive pain control and pulmonary hygiene. These patients often will receive systemic analgesia with opiates to decrease the incidence of these respiratory complications, which leads to its own set of opiate associated-complications, including constipation, delirium and dependence.

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Sound Waves for Shoulder Dislocations

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Sound Waves for Shoulder Dislocations

Shoulder injury and dislocations are common reasons for patients to present to the emergency department (ED) for evaluation. As ED physicians we often must determine whether the shoulder is fractured, dislocated, or both. Most of the time this is done through the use of physical examination in addition to the use of a plain film radiograph of the shoulder.

 The use of ultrasound in the diagnosis and management of musculoskeletal injuries is becoming more common. While it currently does not supplant the use of radiographs, it can be a useful adjunct to the management of these patients.

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Ultrasound of the Month: No Definitive Yolk Sac, No Definitive IUP!

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Ultrasound of the Month: No Definitive Yolk Sac, No Definitive IUP!

Is that a yolk sac? a fetal pole? not sure? Then it’s not a DEFINITIVE intrauterine pregnancy! Medical student Michael Brooks discusses a case of indeterminate findings that led to a diagnosis of ectopic pregnancy. He highlights the findings suggestive of an ectopic pregnancy on POCUS and difficulty in making the diagnosis!

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The Lever Test for Diagnosing ACL Injuries

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The Lever Test for Diagnosing ACL Injuries

The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligaments, with nearly 200,000 injuries annually in the US, with ~100,000 requiring reconstruction. The ACL prevents anterior translation of the tibia relative to the femur and is a secondary restraint to tibial and varus/valgus rotation. Accurately diagnosing ACL injuries in the ED after an acute knee injury remains difficult. The diagnosis is complicated because clinical tests are performed on an acutely injured knee, which is likely swollen and painful, leading to muscle contractures and patient apprehension. As Emergency Medicine physicians, we must have some confidence in suspicion of an ACL tear because not all patients can or should be referred for prompt orthopedic follow-up. 

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Grand Rounds Recap 10.4.23

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Grand Rounds Recap 10.4.23

This week’s Grand Rounds kicked off with a series of involved cases including endocarditis strokes, Tasotsubo cardiomyopathy and more. Dr. Freiermuth gave us an update on the landscape of research and move to adaptive designs. Drs. Sookdeo and Diaz gave talks on RCVS, PRES and compartment syndrome for some core content.

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Diagnostics and Therapeutics: Managing Pneumothorax

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Diagnostics and Therapeutics: Managing Pneumothorax

There are many different types of pneumothorax (PTX), and the management paradigm has shifted in recent years as the research has exploded on this topic. This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Institutional resources and specialty services may further dictate the management of PTX. This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department.

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Grand Rounds Recap 9.27.23

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Grand Rounds Recap 9.27.23

It was a stellar week here at UCEM Grand Rounds! We kicked off the day with a lecture from our colleague at CCHMC, Dr. Dean, about management of pediatric airways. We then transitioned to a review of landmark studies in EM, specifically with regards to targeted and systemic thrombolysis for MI, stroke, and PE. We continued our day by discussing evidence based medicine and the implementation of this in the prehospital setting with EMS faculty, Dr. Richards. Next, Drs. de Castro and Thompson faced off in an epic battle of CPC where we covered the diagnosis and management of euglycemic DKA. This was then followed by Dr. Vaughan’s R1 diagnostics and therapeutics lecture on pneumothoracies. Finally, we wrapped up the day with Dr. Gillespie’s R4 capstone lecture.

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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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