Troublesome G-Tubes

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Troublesome G-Tubes

Replacing gastrostomy tubes that have fallen out or are no longer functioning is a common procedure in the Emergency Department. Often, these replacements are smooth and easy. There are times however when the replacement process can get complicated with the need to dilate quickly stenosing tracts and/or the need to consult a sub specialist to assist with replacement. This post covers the key historical factors to gather on these patients and the basics steps in replacing the tubes.

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Troubleshooting Foley Caths and Suprapubic Caths

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Troubleshooting Foley Caths and Suprapubic Caths

Placement of a foley catheter is usually a simple process. However when it doesn’t go smoothly, when the foley just won’t seem to pass, there are specific approaches that are needed to successfully catheterize the patient. Suprapubic catheters will also frequently need replacement and troubleshooting in the ED.

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Grand Rounds Recap 12.6.23

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Grand Rounds Recap 12.6.23

What a great Wednesday at UCEM Grand Rounds! To start off the morning, we had the absolute honor to host NFL Players Association Medical Director Dr. Thom Mayer who guided us through a lesson on leadership via examples in the NFL. We then transitioned to our quarterly EMS grand rounds where we discussed updated Southwest Ohio EMS protocols with EMS fellow Dr. Weekley. Following this, we brought out our competitive sides by participating in a game of sports medicine jeopardy led by Dr. Betz, one of our sports medicine trained faculty members. Dr. Fabiano then gave an insightful capstone lecture on reflecting on what you want to do with your life, particularly outside of our careers. We then transitioned back to the clinical space for Dr. Snyder’s informative lecture on prosthetic valve emergencies. Finally, we wrapped up the day with a quality improvement and knowledge translation lecture about spontaneous intracerebral hemorrhage.

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Grand Rounds Recap 11.29.23

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Grand Rounds Recap 11.29.23

This week’s grand rounds was packed with education! We started off the day with our morbidity and mortality conference which was led by chief resident, Dr. Stark. She discussed multiple high yield cases including immunosuppressed patients with fever, subarachnoid hemorrhage, complex trauma resuscitations, stridor in the adult, posterior circulation stroke, and finally an interesting case of Lemierre syndrome. Following M&M, Dr. Wolski took on Dr. Broadstock in an epic clinical pathologic case where the ultimate diagnosis in a child with abdominal pain was a bezoar. This was then followed by Dr. Newton’s R1 Diagnostic and Therapeutics lecture on Troubleshooting tubes in the ED including G-tubes, foley catheters, and suprapubic catheters. Finally, we wrapped up the day with R3 small group sessions. Dr. Harward led a session on ***. Meanwhile, Dr. Moulds discussed pharmacotherapy. Last but certainly not least, Dr. Sobocinski reviewed ***. All around, an excellent day at UCEM Grand Rounds!

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Grand Rounds Recap 11.8.23

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Grand Rounds Recap 11.8.23

We start off the day with our quarterly Airway Grand Rounds, where Dr. Carleton discussed the intricacies of performing an awake look intubation. We then transitioned into a brief operations update on the department, followed by a great discussion regarding heavy metal toxicity with Dr. Boyer during his R1 Clinical Knowledge lecture. We were then honored to host Dr. Curran, an associate professor in the Division of Hematology Oncology and specialist in acute hematologic malignancies, for our consultant corner where we discussed acute leukemia. Finally, we wrapped up the day with combined grand rounds with our pediatric colleagues where we practiced a case of DKA during simulation as well as discussed pediatric EKGS and airways. Lots to learn this Wednesday!

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Diagnostics and Therapeutics: Ear Emergencies in the Department

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Diagnostics and Therapeutics: Ear Emergencies in the Department

Ear trauma, pain, and infection are a few of the common presenting complaints in emergency departments across the US, accounting for millions of visits annually. This post aims to review the diagnosis and treatment approaches for common ear emergencies including auricular hematomas, outer ear infections, and retained foreign bodies.

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Grand Rounds Recap 11.1.23

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Grand Rounds Recap 11.1.23

This week Grand Rounds kicked off with a range of complicated cases including of choledocholithiasis, syphilis, and hyperthermic-associated toxidromes. Dr. Bryant than presented on burns in a low resource setting for our global health lecture. Drs. Goel and Thompson discussed the decision rules for head and C-spine imaging. And Drs. Gallen, Brower and Finney finished off our resident lectures for our core content.

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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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