TRAUMA YELLOW
  • Clinical
    • Discharge Macros
    • Suboxone
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map

Lightning Rounds: Submersion Injuries

8/24/2016

2 Comments

 
Especially in the summer, children, and young men are at higher risk of submersion injuries. 

Management of a drowning victim

When a patient is identified in an active drowning situation;
  • Call for backup: Scene safety and utilization of appropriately trained personnel is important to prevent additional victims. 
  • Drowning victims have alveolar collapse due to surfactant removal.
  • "Dry Drowning" refers patients who drown with laryngospasm, preventing active water movement into the lungs. 
  • Submersion for longer than 10 minutes predicts a much worse outcome than those submersed < 10 minutes. 
  • Patients should be observed for 4-6 hours after a partial drowning event. 
drowning_epidemiology.pdf
File Size: 207 kb
File Type: pdf
Download File

multiorgan_dysfunction_drowning.pdf
File Size: 744 kb
File Type: pdf
Download File

2 Comments

Preoxygenation & Apneic Oxygenation

8/24/2016

2 Comments

 
Adapted from Will Denq's Grand Rounds presentation August 24th, 2016
A discussion of preoxygenation as well as the role of high flow nasal cannula and apneic oxygenation in the emergency setting. 
Picture
Source: http://www.esicm.org/ (Shutterstock)

Read More
2 Comments

Acute Chest Syndrome in Sickle Cell

8/17/2016

3 Comments

 
Adapted from Colton Hood's August 17th 2016 Grand Rounds lecture.
One of the most common and severe complications of sickle cell disease, clinically may resemble a pneumonia, and can develop suddenly, and is more common in patients with asthma or those with prior acute chest events. ​Typically presents with cough, shortness of breath, and rales accompanied by a new infiltrate on chest X-ray. 

Mortality of acute chest syndrome is 9% in adults, and can lead to pulmonary hypertension, right heart failure, and risk of sudden death. 
Picture
Source: http://www.ssajm.org/text.asp?2014/1/3/111/138930
Evaluate patients with sickle cell disease with acute onset of lower respiratory tract disease with or without fever for acute chest syndrome, including chest x-ray and pulse oximetry to measure oxygen saturation (NHLBI Consensus-Panel Expertise)

Read More
3 Comments

Lightning Rounds: Syncope

8/17/2016

3 Comments

 

Appropriate Syncope Workup

Picture
  • ​EKG
  • Electrolytes: Not predictive of poor outcomes, and should not be part of your workup without a clinical suspicion.  
  • Head CT: Only useful in those with neurologic deficits or focal symptoms during the syncopal episode, or those with trauma. ACEP Choosing Wisely. 
  • CBC:  Anemia is predictive of poor outcomes, and patients should be evaluated if at risk for anemia (elderly, females with heavy menses, GI bleeds, or a concerning history). Utilized in the San Francisco Syncope Rule. 

EKG Abnormalities in Syncope

  • Tachyarrhythmias
  • Bifascicular block or conduction delay
  • Bradycardia/AV block
  • Prolonged or shortened QT interval
  • Brugada pattern (RBBB with ST elevation)
  • WPW
  • Hypertrophic cardiomyopathy: sharp, deep Q waves in lateral leads, 
  • Ischemia
  • ARVD: Epsilon wave or negative T waves in precordial leads: Right sided cardiomyopathy, Typically presenting in young patients with a history of syncope. 
Picture
Epsilon Wave

Disposition of Syncopal Patients

PictureACEP Risk Factors in Syncope
  • Suspected or diagnosed cardiac cause of syncope
    • Abnormal EKG
    • History or cardiac disease (CHF, low EF, new murmur)
    • Exertional Syncope
    • Sudden onset without a prodrome
  • Anemia or other lab abnormalities
  • ACEP Clinical Policy for Syncope Management


3 Comments

COPD Exacerbations & Antibiotics

8/17/2016

3 Comments

 
Adapted from Molly Graham's August 17th 2016 Grand Rounds presentation.

Treatment of acute COPD exacerbation

Acute exacerbations are characterized by sustained (48 hours or more) worsening of shortness of breath and coughing, with or without sputum. The most common cause is a viral or bacterial infection. 
  • Therapy with short-acting beta2 agonists and anticholinergic bronchodilators
  • Oral corticosteroids (e.g., prednisone 25-50 mg/day) for less than two weeks in most moderate to severe COPD patients. A dose of 30–40 mg of prednisone equivalent per day has been used in practice.
  • Antibiotic use is based on risk factors; evidence shows that antibiotics improve outcomes in those with critically ill COPD exacerbations, however mild or moderate exacerbations are not improved by antibiotics. 

Risk Factors

  • Age >65
  • FEV1 <50 % of predicted
  • > 4 exacerbations / year
  • Ischemic heart disease
  • Use of home oxygen
  • Chronic oral steroid use
  • Antibiotic use in the past 3 months. 
Source: British Columbia COPD Guidelines
Picture
Common Co-morbidities in COPD

Procalcitonin Levels

Peptide inflammatory marker currently being evaluated for use as a POC marker for inflammatory and infectious disease. 

Evaluation of COPD exacerbations with procalcitonin can decrease antibiotic use.

A PCT <0.1ng/mL indicates patient outcomes will not be improved with antibiotics.
Procalcitonin for COPD.pdf
File Size: 579 kb
File Type: pdf
Download File

3 Comments

From the TR: CT before Lumbar Puncture

8/12/2016

2 Comments

 
Before every lumbar puncture many providers reactively get a CT to rule out a mass or reduce the risk of herniation, However, not every patient requires a CT. 
Picture

Read More
2 Comments

EKG in PE

8/3/2016

2 Comments

 
Picture
Case: 22F cc: chest pain, dyspnea
Dx: Pulmonary embolism

​EKG changes in PE:
  • sinus tachycardia (44%)
  • complete or incomplete RBBB (18%, and inc mortality)
  • RAD (16%)
  • dominant R wave in V1
  • P pulmonale (95-peaked P in II >2.5)
  • persistent S wave in V6
  • RV strain pattern
    • STD and/or TWI in inferior and anterior leads (II, III, aVF, V1, V2, V3)
  • S1Q3T3 (only in 20% of PE)

Picture
2 Comments

Mechanical Ventilation

8/3/2016

3 Comments

 
Dr. Yamane's Guide to reading and using a vent. 
  • Indications
  • Parameters
  • Modes
  • Reading a Waveform
  • Discontinuation
Picture

Read More
3 Comments
    Categories

     

    All
    Abx
    Article
    Cardiac
    EKG
    EKG Challenge
    GI Bleed
    Grand Rounds
    Headache
    ICU
    Orthopedic
    Pain
    Peds
    Reading
    Stroke
    Subarachnoid Hemorrhage
    Syncope
    Teaching Pearl
    Trauma
    Travel
    Zika

    Archive

     

    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    January 2016
    December 2015
    November 2015

    Picture
    Please read our Terms of Use.
Donate
This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

​Please refer to our Terms of Use. 
  • Clinical
    • Discharge Macros
    • Suboxone
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map