Ultrasound GR: cardiac ultrasound - dei: embracing individuality - pediatric emergency procedures - pediatric potpouri - pediatric foreign body aspiration Ultrasound Grand Rounds: The Tell-Tale Cardiac Ultrasound WITH Dr. broadstock Right ventricle evaluation   RV size  Moderate RV dilation is when RV:LV ratio is greater than 1:1  Studies show this is 98% specific and 50% sensitive for PE  TAPSE (Tricuspid annular plane systolic excursion)  Greater than 1.8 cm is normal Hazard ratio in patients with abnormal TAPSE in normotensive patients is high e ..read more

Leadership curriculum: recruiting & building a team r4 Case follow-up - r3 small groups Leadership curriculum: recruiting & building a team WITH Drs. fermann and lAfollette The best leaders understand that the critical component to their success as a leader is building a great team around them This involves getting the right people involved in your organization and empowering them to do their job well Recruitment is not a one person job and should involve the entire team recruiting other members If you want your organization to be better, you need to be an active participant ..read more

r4 case follow up - r1 clinical knowledge: interstitial lung disease - halo - pediatric simulation - pediatric small groups r4 case follow up WITH dr. yates Psychiatric emergency department visits are on the rise in the United States, with roughly 15-19% of all ED visits associated with mental health diagnoses Roughly twenty percent of patients presenting with psychosis have a secondary cause Work up should be determined by the history and physical and may need to be broad, but all patients should receive a POC glucose Be particularly cautious in patients of vulnerable populations, inc ..read more

airway grand rounds - r1 clinical knowledge: heavy metals - consultant corner: acute leukemia - pediatric sim - pediatric cases airway grand rounds WITH dr. carleton Difficult airway algorithm: when should we RSI? When you are forced to act immediately  When reoxygenation and intubation is likely to be successful and a patient is able to tolerate a period of apnea (is not likely to become profoundly hypoxic nor hypercarbic)  How to perform a successful awake look intubation when RSI not indicated: Preparation  Optimize patient positioning and other characteristic ..read more

Mahajan P, VanBuren JM, Tzimenatos L, et al. Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics 2022;150(4). 10.1542/peds.2021-055633 Question What is the prevalence of bacteremia and/or bacterial meningitis (“invasive bacterial illness”, ISI) in febrile infants ≤60 days of age with a positive urinalysis (UA) result? Study Design This study was a secondary analysis of a dataset collected prospectively to examine noncritical febrile infants ≤60 days old who had at least a blood culture collected (original study: doi.org/10.1001/jama.2016.9207). T ..read more

CPC: Rheumatic Fever - Carbon Monoxide Poisoning - Pediatrics: Toxicology - Combined EM/IM: Competency CPC: Rheumatic Fever WITH Drs. Chhabria and Baez Case: Young patient presenting with R knee pain x5 days, progressing now with SOB and CP History notable for flu-like symptoms for past 2 weeks Physical exam notable for tachycardia, tachypnea, muffled heart sounds + murmur and gallop, R knee and elbow swelling Remarkable diagnostics:  CXR - cardiomegaly, no PNA Labs - new anemia, CRP elevation, elevated d-dimer, troponin, and BNP EKG - sinus tachycardia, R axis deviation, R ..read more

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