The Approach to Neuromuscular Weakness

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The Approach to Neuromuscular Weakness

Weakness is a common, though sometimes vague, presenting symptom in the ED. Neuromuscular (NM) weakness can have various causes, ranging from common and relatively easy to diagnose conditions (such as strokes and trauma) to less common and more difficult to diagnose ones (such as vascular pathologies, infections, autoimmune diseases, and neoplasms). This post focuses on how to localize weakness to differentiate types of NM weakness and presents classic cases of diffuse weakness caused by three diseases.

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Grand Rounds Recap 8.14.24

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Grand Rounds Recap 8.14.24

Join us as one our OBGYN consultants, Dr. Pensak, takes us through the intricacies and varied management of early pregnancy loss. Then, Dr. Lang takes us through STEMI equivalent presentations as well as sneaky STEMI mimics! Finally, our education was rounded out with our pediatric triple threat. We discussed NRP and simulated resuscitation of a bradycardic neonate, practiced umbilical vein cannulation as well as considered a prolonged fever work-up in a case of Kawasaki and the intricacies of lumbar punctures in the pediatric population!

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Grand Rounds Recap 8.07.2024

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Grand Rounds Recap 8.07.2024

Join us for another week of Grand Rounds! We had a visit from Dr. Melissa Platt of the ABEM Board of Directors discussing the upcoming changes to the ABEM certification exam. Dr. Lawton presented to us about frequent fliers in the Emergency Department. Dr. Shewakramani spoke to us about sepsis metrics and operational changes that have been made in our department, and we closed with an exciting R3 Taming the SRU lecture with Dr. Artiga discussing difficult intubations.

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Grand Rounds Recap 7.31.24

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Grand Rounds Recap 7.31.24

Join us for another exciting week of Grand Rounds! Today we discussed capacity management and ED throughput, discussed best practices for bedside teaching and and giving a presentation, discussed disposition for orthopedic complaints in the community, reviewed skin adhesives and hypertensive emergency, and listened to a “year in review” of some of our most exciting ultrasound cases from the previous academic year.

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Grand Rounds Recap 7.24.24

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Grand Rounds Recap 7.24.24

We started off this week with our first morbidity and mortality conference of the year given by chief resident Dr. Moulds. Dr. LaFollette then shared clinical pearls with us from multiple case follow ups followed by Dr. Brower who discussed the evidence behind a multitude of superstitions. We finished up with a lecture from dual EM/PEM trained faculty Dr. Cindy Chang who discussed high risk, low prevalence diseases in children.

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Grand Rounds Recap 7.10.24

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Grand Rounds Recap 7.10.24

We started off this week with femoral nerve block case review with Dr. Lori Stolz, followed by our first ever morbidity and mortality conference focused on community practice given by Dr. Hughes. Next, Drs. Boyer and Benoit faced off in the clinical pathologic case lecture. Dr. Moulds covered high yield ophthalmology visual diagnosis, and Dr. Baxter discussed time sensitive vascular pathology. We finished off the day with Drs. Richards and Demel who discussed the operational aspects of stroke care.

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Sniffing out Sepsis - Vibes vs Scoring Systems?

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Sniffing out Sepsis - Vibes vs Scoring Systems?

Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well  as the rest of the world. Sepsis as a disease process has been difficult to both clearly define and quickly recognize. Many metrics for recognition and management of sepsis are dependent upon various scoring systems, including SIRS, SOFA, qSOFA, and MEWS, none of which were designed for the acute detection of sepsis within the emergency department. This journal club recap will look at an article by Knack et al looking at physician gestalt vs scoring systems for the detection of sepsis.

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Grand Rounds Recap 7.17.24

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Grand Rounds Recap 7.17.24

We started off this week with a lecture and small groups discussing different leadership styles. This was followed up by a fantastic discussion on interpersonal and community violence with Drs. Jarrell and Kimmel. We then reviewed all things early pregnancy ultrasound with the one and only Dr. Stolz and ended with a great review of landmark studies in EM with Dr. Freiermuth.

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But the INR is 3.2! Markers of Coagulation Status in Cirrhotics

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But the INR is 3.2! Markers of Coagulation Status in Cirrhotics

In patients with cirrhosis and ongoing bleeding, it can be challenging to determine whether or not patients are hyper or hypocoagulable. Traditional markers of coagulation status like INR can be difficult to interpret in patients with abnormal synthetic function and potentially increase consumption of coagulation factors. Can TEG (thromboelastography) be a helpful too in these situations? In this journal club recap, Dr. Grisoli recaps a recent article by Rout et al that addresses this issue.

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Shock Differently - Out of Hospital Cardiac Arrest

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Shock Differently - Out of Hospital Cardiac Arrest

Out of hospital cardiac arrest (OOHCA) represents a great cause of morbidity and mortality. Approximately 350,000 cardiac arrests occur in North America annually and 20% can be attributed to Ventricular tachydysrhythmias (i.e. ventricular tachycardia [v fib] and ventricular tachycardia [v tach]without a pulse). In this journal club recap, Dr Kelly Tillotson recaps an article comparing different ways of defibrillation and their effect on outcomes in OOHCA

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