Grand Rounds Recap 10.30.24

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Grand Rounds Recap 10.30.24

Join us for another great week of Grand Rounds! We started out with a great discussion of the changing workforce and how the differences between generations and leadership styles impacts our interactions with our colleagues. Then we discussed the nuances of managing a dysfunctional tracheostomy with Dr. Adan. We were taken through the pathophysiology and clinical presentation of patients with pneumomediastinum and mediastinitis with Dr. Valles. Finally, Drs. Artiga, Beyde and Vaishnav gave us hands on practice with the different types of nerve blocks that can be used in the ED!

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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 9.6.23

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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 10.12.22

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Grand Rounds Recap 10.12.22

Starting off the week with Drs. Jarrell and Yates defining what advocacy looks like in leadership. Drs Finney and Chuko led us in two case follow up discussions featuring how to deal with early misses and Hickam’s Dictum. Finally the Cincinnati Peds team leads up in simuations of Status Asthmaticus.

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Trio of Trauma - Journal Club Recap

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Trio of Trauma - Journal Club Recap

The care of trauma patients is constantly evolving. From the time of injury to OR or ICU, there are dozens of management decisions that can improve the care and outcome for your patients. In our most recent journal club we took a look at 3 articles that looked at the management of trauma patients in the ED and ICU. Should we be adding vasopressin to our massive transfusion protocols? Is DL dead for trauma patients? Should we move to use IO’s early in traumatic arrests?

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Ketamine Potpourri

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Ketamine Potpourri

In our most recent journal club, we took a look at 3 articles focused on the use of ketamine in the Emergency Department. When treating pain with ketamine, does a rapid administration of ketamine result in more dysphoria? When used for RSI, is ketamine more hemodynamically stable than etomidate? When using ketamine for procedural sedation in adult patients, does pre-treatment with versed or haldol decrease clinically significant emergence agitation?

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Swelling out of the Blue - Angioedema in the ED

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Swelling out of the Blue - Angioedema in the ED

Angioedema is like urticaria in that both are transient swelling of well-demarcated areas. However, angioedema involves swelling of deeper tissues, producing nonpitting edema of the dermis and subcutaneous layers. It is most often seen in the eyelids and lips, and sometimes in the mouth and throat. While it is not pruritic it may be painful. In the US, angioedema accounts for approximately 100,000 ER visits annually (1). Across the world, 35% of prescriptions written for hypertension are for ACE-inhibitors (>40 million people). With a reported incidence of angioedema in 0.1–0.7% of those patients on ACEI, there are approximately 40,000 cases of ACEI-associated angioedema worldwide annually (2).

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Ultrasound case of the month - Placement comes first

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Ultrasound case of the month - Placement comes first

This month, the Taming the SRU ultrasound team details some of the procedural applications of ultrasound in the midst of the COVID-19 pandemic, fresh from two of the minds our intern class: Drs. Hamza Ijaz and Chris Zaleky. This combo post will discuss the use of ultrasound to confirm placement of both endotracheal tubes and central venous catheters.

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Grand Rounds Recap 12.4.19

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Grand Rounds Recap 12.4.19

After a brief hiatus we returned to grand rounds this week and started off with an in depth discussion on common overdoses and treatments in the ED with our guest lecturer and expert toxicologist Dr. Gillian Beauchamp. We then got some hands on time with the new hand held ultrasound machines that are now available on Air Care as well as reviewed pre-hospital management of traumatic pneumothoaces with Dr. Humphries. Finally, airway guru Dr. Carleton took us on a deep dive on airway management in angioedema.

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Grand Rounds Recap 11.6.19

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Grand Rounds Recap 11.6.19

This week Dr. Irankunda and Dr. Berger took us through their excellent QIKT on strangulation and asphyxiation. Dr. Knight walked us through the initial ventilator management in the ED. Dr. Habib talked about some common mythology and Dr. Makinen lead us through a physiologically challenging airway in a sick trauma patient. Ended with a thrilling R4 sim focusing on altitude illnesses.

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The Shocked Intubation: Definitive Airway Sans Hypotension

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The Shocked Intubation: Definitive Airway Sans Hypotension

Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation.  Yet few words together strike greater fear in the minds of savvy resuscitationists.  Not because we cannot deftly manage shock, or because we are anything but hardy intubators, but because the swiftest way to transform a living patient into a dying patient or a dying patient into a dead patient is to brazenly intubate someone who is in shock.  What are the root causes of endotracheal intubation's (ETI) hemodynamic effects and, most importantly, how do we circumnavigate them?  Read on to learn how to safely intubate the patient in shock…

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