Ultrasound Guided Nerve Blocks in the ED - CPC w/ Dr. Harward - Pediatric Simulation: Seizure Ultrasound guided nerve blocks in the ed WITH Dr. Arun Nagdev Visit http://highlandultrasound.com/ for in depth discussion of each block with accompanying ultrasound and anatomy images Best practices for pain management in the ED Active Non-siloed Should be available 24/7 Multimodal Blocks, ketamine, NSAIDs, APAP Goal is not 100% resolution with blocks, 50% is success with multi-modal treatment Ketamine assisted blocks: 25mg ketamine in 100cc piggyback infused during bl ..read more

EMS Protocol: prehospital ketamine for agitation - Aortic dissection - anterior cord syndrome - tumor lysis syndrome - Pediatric Visual Diagnosis EMS Grand Rounds w/ Dr. Fisher Updates in the 2023 SW OH Protocol Prehospital Ketamine for Agitation Background: Prospective observational study showed faster time to sedation with 5mg IM ketamine (5 min) vs. 10 mg IM haloperidol (17 min) Haldol patients required redosing Intubation higher in ketamine group (39% ketamine vs 5% haloperidol) Retrospective studies with mixed reviews, some with safe adverse effect profile, some with h ..read more

R4 Case Follow Up With dr. frederick: Massive Upper gi bleed - CPC with Drs. Kletsel and ham - R1 clinical diagnostics: “dysnatremias” with dr. chhabria - r3 Taming the Sru with dr. frankenfeld: Basilar Stroke - Combined peds lecture with cchmc: Pediatric broken bones r4 case follow WITH dr. frederick Massive Upper GI Bleed A massive upper GI bleed can be defined in the following ways: GI bleeding with a Hgb < 7 An abnormally elevated shock index 500cc of hematemesis in 24 hours Any volume of hematemesis that makes an ED provider say “Oh boy that’s a lot of blood!” Mimics of ..read more

AIRWAY GRAND ROUNDS WITH DR. CARLETON - R4 CAPSTONE WTIH DR. LAURENCE - R1 CLINICAL DIAGNOSTICS: ATYPICAL HEADACHES WITH DR. GLENN - R2 CPC: DIGOXIN TOXICITY WITH DRS. KEIN AND ADAN - PEDIATRIC SIMULATION AIRWAY GRAND ROUNDS WITH DR. CARLETON Endotracheal Tube Exchange Some suspected cuff leaks are not cuff leaks, but rather are due to proximal migration of the ETT. Depth at teeth is not  a reliable predictor of appropriate ETT position.  Management by ETT removal and attempted DL reintubation had unacceptable failure rate and complications - 46% esophageal intubation, 50% hypoxia, 2 ..read more

R4 SIMULATION WITH DRS. CONNELLY, HASSANI, HUNT, IRANKUNDA - R4 CAPSTONE WITH DR. IRANKUNDA - PEM-EM COMBINED CONFERENCE: VOMITING IN PEDIATRICS With DR. NANCY CLEMENS R4 SIMULATION WITH DRS. CONNELLY, HASSANI, HUNT AND IRANKUNDA Aortic Dissection Epidemiology Occurs in ~3/100,000 patients per year  Males >>> females  Median age is 63  In those <40, more than half of cases are associated with either Marfan syndrome or bicuspid aorta -       Risk factors  HTN (76%) Atherosclerosis (27%) Aortic aneurysm (16%) Previous cardiac s ..read more

Conflict Resolution with Drs. Leenellet and McDonough - R3 Taming the SRU: Postpartum Hemorrhage with Dr. Kimmel - R1 Clinical Knowledge: Toxic Gas Exposure with Dr. Chhabria - Pediatric Emergency Medicine: Trauma with The PEM Fellows Conflict Resolution with Drs. Leenellet and McDonough Take time to plan and assess what you want out of a difficult conversation and where the other person is coming from. Think through the best and worst case scenarios, as well as the possible long-term fallout. Assess what your own visceral response to conflict is, and implement strategies to mitigate it: Bo ..read more

OBGYN Consultant Corner: Delivery Complications with Dr. Boldt - EM Lit BLItz with Dr. Zalesky - R4 Capstone with Dr. Hassani - Quarterly PEDS SImulation and Small group Cases with the PEM TEAM OBGYN Consultant Corner: Delivery Complications WITH Dr. Boldt Nuchal Cord One loop occurs in 20-34% of deliveries, Two loops in 2.5-5%, and three loops in 0.2-0.5% It is not associated with adverse perinatal outcomes Management Reduce it after delivery of the head, OR Deliver through the cord loop, OR If you think the cord is constricting, you can doubly clamp it and cut it and proceed w ..read more

OH-TF1 SURFSIDE RESPONSE WITH DR. CURRY - QI/KT NSTEMI WITH DRS. KEIN AND STARK - R4 CASE FOLLOW-UP: BASILAR STROKE WITH DR. HUNT - CPC: PEDIATRIC ACUTE URINARY RETENTION WITH DRS. MILLIGAN AND BENOIT - R3 SMALL GROUPS: “THERE WILL BE BLOOD” WITH DRS. GOFF, RAMSEY, AND ZALESKY URBAN SEARCH & RESCUE: OH-TF1 SURFISIDE RESPONSE WITH DR. CURRY Champlain Towers South Collapse - 13-story building, likely started around the pool deck Timeline:  Collapse on 6/24 at 0130 OH-TF1 placed on “Alert” to roster a Type 1 team at 2030 on 6/24 OH-TF1 activated on 6/30, to persons at 1430, departe ..read more

R1 CLinical Knowledge: Mesenteric Ischemia with dr. haffner - R4 Capstone with Dr. Roblee: Coping with Patient Death - Quality Improvement patient safety with Dr. Thompson- Trauma consultant corner: Product resuscitation with dr. goodman- pediatric emergency medicine combined conference: neonatal sepsis R1 Clinical knowledge: Mesenteric ischemic WITH Dr. Haffner The Case An elderly male presents with a chief complaint of abdominal pain, nausea, and vomiting. The pain started suddenly two hours prior to arrival, it is constant, and 10/10. He has a history of a myocardial infarction 2 weeks ..read more

Morbidity and Mortality - Ultrasound Grand Rounds - R4 Capstone - R3 Small Groups MORBIDITY & MORTALITY WITH DR. LI Case 1: Methamphetamine Intoxication While previously more common on the west coast, methamphetamine use has become more common throughout the U.S. and especially in Ohio (most common drug used in Hamilton County, OH for the past 3 years) Concomitant rates of patients assaulting nurses, residents, and attending physicians is high Methamphetamine intoxication can be a great masquerader, like syphilis and TB, presenting similarly to sepsis, anticholinergic toxicity, etc ..read more