Feature Film - Wound Care Pitfalls in the Emergency Department

Feature Film - Wound Care Pitfalls in the Emergency Department

Matthew Delaney is an emergency physician who also helps run a wound care clinic.  With these dual roles, he has gained a unique perspective on both acute and chronic wounds that present to the emergency department.  In this feature film, he discusses some pearls and pitfalls of wound care in the emergency department. 

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So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

In the United States an estimated 300,000 sports-related concussions occur annually. Many of these are young athletes who are referred to the emergency department for evaluation. While there are robust clinical decision aids to clarify the need for a CT brain, the literature around concussions is a bit murkier. Recently, athletes who sustained a concussion were recommended to avoid exercise and vigorous cognitive activity until their symptoms resolved entirely. Several studies over the last several years have challenged these recommendations. Dr. William Meehan is the director for the Micheli Center for Sports Injury Prevention. We were fortunate to “pick his brain” regarding questions we are often asked by the parents of the young athlete . . . when can their child return to play? When can they return to their full course work at school?

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Journal Club January 2018 - Cervical Spine Fractures in the Elderly

 Journal Club January 2018 - Cervical Spine Fractures in the Elderly

Geriatric patients (> age 65) account for almost 1 in 5 of all cervical spine fractures, with 50% of cervical spine fractures occurring at the C1/C2 level.  Recent literature has questioned whether these clinical decision rules may be applied in the geriatric population, where over half of identified cervical spine fractures result from ground level falls.  Furthermore the reliability of physical exam, specifically midline tenderness, has been questioned in elderly patients.  January's journal club examined three articles that addressed this specific population of blunt trauma patients at risk for cervical spine injury. 

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Feature Film - Could There Be Light At The End Of The Behavioral Health Tunnel?

Feature Film - Could There Be Light At The End Of The Behavioral Health Tunnel?

Tomorrow, countless acute mental health patients will present to their local emergency department asking for help.  Our typical response?  Detain them for days until definitive resources are available.  Ironic for a specialty whose defining characteristic is timely diagnosis and treatment.  Door to balloon time for STEMI?   t-PA for stroke within the window?  Most emergency departments have complex operations, funding and resources to meet these goals.  How about a door to psychiatric bed time?  Not so much.  Sadly, the behavioral health care crisis in this country is only getting worse. While the demands on emergency providers to treat these patients continues to rise, resources continue to decline.  In this feature film, Dr. Kivela, current ACEP president, proposes some novel solutions to improve the care, cost and boarding times for this vulnerable population.  

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Journal Club November 2017 - Large Vessel Strokes

Journal Club November 2017 - Large Vessel Strokes

Ischemic stroke is one of the most frequently encountered neurologic emergencies. It can be a truly debilitating diagnosis, and yet classically, there has only been one treatment available for small and large vessel occlusions alike– tPA. Now, with the widespread availability of CT angiography and the advent and maturation of interventional techniques such as mechanical thrombectomy, the management of large vessel occlusion (LVO) strokes is rapidly evolving and is increasingly distinct from the management of other strokes. This is truly an exciting time in stroke care, so for this month’s journal club we focused on three questions relevant to the emergency provider:  1) What is the utility of prehospital clinical scales for rapidly identifying LVO strokes? 2) Should patients with suspected LVO be taken to the nearest stroke center or bypass smaller hospitals to reach a comprehensive stroke center?  3)  How effective is mechanical thrombectomy vs. tPA alone?

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Enhancing Human Performance and Flow in Resuscitation

Enhancing Human Performance and Flow in Resuscitation

Mike Lauria was a pararescueman, providing medical/rescue support for special operations throughout the world.  Through this experience, he learned how to use psychological skills to perform under acute stress.  We were fortunate to have him join our winter symposium this year, discussing the cognitive science behind stress and performance, as well as how to use performance enhancing psychological skills for acutely stressful conditions. 

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To the Cath Lab or Not? You Make the Call! - Part 2

To the Cath Lab or Not?  You Make the Call! - Part 2

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Here is part two of our two part series (click here for part one).  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

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