Grand Rounds Recap 05.29.24

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Grand Rounds Recap 05.29.24

Another week, another great Grand Rounds line-up at UCEM. We start off with our monthly Mortality and Morbidity Conference led by Chief Resident Dr. Finney. This session covers cases from the month of April- including the treatment of a canine in the SRU. One of our SRU leaders, Dr. Chhabria, shares the changing landscape of cardiac arrest management using ECMO. Next up, Dr. Thompson helps us reflect on the self-talk that we engage in on a daily basis and offers advice on how to improve our mindset- especially when we are on-shift. We learn from Dr. Kotei how to better ED proceduralists when encountering patients with ascites and/or pleural effusions. We end with Dr. Hajdu challenging Dr. Baez to solve a puzzling case of progressive vision loss in a otherwise healthy young patient.

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Grand Rounds Recap 8.31.22

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Grand Rounds Recap 8.31.22

This week’s Grand Rounds started with 2 hours of M&M tips with Dr. Broadstock, Small groups followed with Thoracentesis with Dr. Milligan, Lung Ultrasound with Dr. yates and Trach Management with Dr. Gillespie. Functional Movement Disorders with Dr. Eltatawy rounded out a great Grand Rounds!

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Grand Rounds Recap 11.3.21

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Grand Rounds Recap 11.3.21

During this week’s Grand Rounds, Dr. Urbanowicz presented Morbidity and Mortality, Dr. Ijaz discussed the diagnosis and management of aortic dissection, Dr. Walsh shares tips for thoracentesis and dosing for systemic tPA, and Dr. Oteng joins us to share his experiences in global emergency medicine.

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Grand Rounds Recap 4.18.18

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Grand Rounds Recap 4.18.18

This week we got a refreshing look at soft tissue ultrasound from our US guru Dr. Stolz. We then moved to the opposite end of modern imaging with the rarely indicated but intermittently very useful KUB by Dr. Skrobut. Drs Kiser and Ventura battled it out in a CPC case of pyloric stenosis then the R4s ran a simulation and small group on global health pathologies.

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EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis

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EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis

Paracentesis and thoracentesis are relatively common procedures in the Emergency Department but the analysis of the fluid can always but a touch confusing.  In this post, PGY-1 Dr. Michael Klaszky walks us through the analysis of pleural fluid and ascitic fluid.

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Thoracentesis

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Thoracentesis

General Considerations

Both the diagnostic and therapeutic thoracenteses are performed using a similar technique. The major difference is the amount of fluid removed. The proceduralist may also choose to only use the needle technique as opposed to the needle-catheter unit when obtaining fluid for diagnostic purposes only.

It is generally recommended that needle size be limited to 18-gauge or smaller to minimize risk of pneumothorax and damage to nearby structures.

US-guided thoracentesis is associated with a significantly lower rate of complications and has become the standard of care. (1)  Real-time ultrasound (US) guidance is recommended for small or loculated effusions when there is concern that the diaphragm or lung tissue is <10mm from the pleural surface. It is also recommended in patients with relative contraindications such as coagulopathies and the mechanically ventilated patient.

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