Grand Rounds Recap 1.3.24

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Grand Rounds Recap 1.3.24

We are back and ready for our first grand rounds of the year! We had a great variety in lectures today. Dr. Wosiski-Kuhn shared her capstone on violence against healthcare workers. Dr. Martella followed up a case of a patient with a spontaneous coronary artery dissection and their puzzling ED clinical presentation. Dr. Guillaume helped us troobleshoot and optimize our options for vascular access including EJ cannulation, ultrasound-guided IVs and all things PICC line. Dr. Haffner took us through a pathophysiology and treatment review of a patient with a very large calcium channel blocker overdose. The R2 team of Drs. Della Porta and Hajdu presented their protocol on alcohol withdrawal in the ED. We learned about the use of panorex as a new study for certain dental patients in conjunction with oral surgery from Dr. Urbanowicz. Finally, Dr. Baez dropped some protips to be confident and competent at a busy community ED site.

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Grand Rounds Recap 7.7.21

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Grand Rounds Recap 7.7.21

Join us as we review another excellent week of grand rounds where neurocritical care fellow Dr. Ham takes us through airway management in the neurocritically injured, Dr. Stolz improves our cardiac ultrasound skills, Dr. Lang discusses the OMI/NOMI EKG findings, Dr. Carleton elevates our use of extraglottic devices, and ENT consultant Dr. Patil provides some tips on managing difficult airways!

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EKG to Activation - A Quality, Quality Metric?

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EKG to Activation - A Quality, Quality Metric?

Time is myocardium, and minimizing door-to-activation time improves outcomes in patients with acute coronary occlusion. There are a number of existing quality metrics used to help drive improvements in the time-based care of STEMI patients. Could a new quality metric help the decision making time of Emergency Physicians?

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Is a STEMI a STEMI in Post-ROSC Patients?

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Is a STEMI a STEMI in Post-ROSC Patients?

One of the first tests ordered for a patient with ROSC following cardiac arrest is an EKG. Many of these EKGs are profoundly abnormal. Current practice is to evaluate for STEMI and to activate the cardiac cath lab if one is found. But, the test characteristics (sensitivity and specificity) of post-ROSC EKGs are likely different than the test characteristics for patients presenting to the ED with complaints of chest pain/symptoms concerning for ACS. This meta-analysis looked to pull together the existing literature and determine those test characteristics for this critically ill patient population. Read the summary after the link and listen to the podcast to hear a breakdown of this study.

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STEMIs in Disguise

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STEMIs in Disguise

The 2013 ACC/AHA STEMI guidelines outline, with specific age and gender-related cutoffs for ST segment elevation in certain leads. While these are clinically important, there are several STEMI equivalents or EKG patterns that do not meet these criteria but should point the practitioner to consult with an interventional cardiologist.  These STEMI equivalents are found in 10-25% of cases of coronary occlusion, making it imperative that emergency personnel be familiar with these patterns. 

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Grand Rounds Recap 3.21.18

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Grand Rounds Recap 3.21.18

This week's Grand Rounds opened with year directives focused on residents as teachers for the junior residents and life as a junior faculty for the senior residents. Next Dr. Fermann discussed implementation of our PE response team (PERT). Dr. Li led a great group discussion on EKG toxicology, Dr. Golden then unsuccessfully tried to stump Dr. Hill with his CPC on phenytoin toxicity, and finally Dr. Gorder gave a fantastic discussion on NSTEMIs.

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EKG Toxicology

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EKG Toxicology

Emergency medicine physicians frequently assess and treat patients who have accidental or intentional poisonings. United States poison centers receive over two million case referrals per year. And, about 20% of these poisonings present to an Emergency Department for evaluation. Evaluation of these patients always includes a history and physical, but further testing can provide valuable information. Blood work is often be needed, but an EKG is a faster, cheaper tool that can provide key pieces of information prompting early interventions. 

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Heart Blocks: A Primer

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Heart Blocks: A Primer

We order and interpret numerous EKG’s during our shifts in the emergency department. EKG interpretation is one of the skills we need to be competent in and comfortable with as an emergency medicine physician. STEMI’s, ischemic changes and arrhythmias are some of the most important findings we focus on, and although straightforward, heart blocks can be easily overlooked. The goal of this post is to go over some of the most common and clinically relevant conduction blocks, how to manage them and what their disposition are.

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Grand Rounds Recap 7.5.17

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Grand Rounds Recap 7.5.17

In our first Grand Rounds of the academic year, we started with Dr. Pancioli teaching us about the history of Emergency Medicine. Dr. Palmer discussed team work and the case for building social capital and Dr. LaFollette worked through the disposition of patients with chest pain. Our clinical pharmacist Chris Droege, PharmD discussed the evolving landscape of agents we have to reverse oral anticoagulants.

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Small Kids and Squiggle Lines - An Introduction to Pediatric EKG Interpretation

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Small Kids and Squiggle Lines - An Introduction to Pediatric EKG Interpretation

It’s a typical shift in your community shop when you see a patient on the board that makes you nervous. 2 year old male with syncope. It’s been awhile since you have treated someone born in the 21st century and you know this child’s workup will likely involve an EKG. The closest pediatric hospital is 2 hours away.  How comfortable do you feel interpreting the squiggle lines generated by this little heart?

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