Grady Report

FOAM of the Week – Drug-Induced Seizures, Iron Toxicity, Serotonin Syndrome and NMS

By Eric Robert Deutsch MD in FOAM of the Week, Neurology, Toxicology

Back from the holidays with some great tox subjects:

New onset or refractory seizures? Think tox! Check out this review of toxicologic causes of seizures from LITFL: http://lifeinthefastlane.com/toxicology-conundrum-023/
Review of iron toxicity from ALIEM: http://www.aliem.com/management-iron-toxicity/
Overview of Serotonin syndrome and NMS from EmDocs: http://www.emdocs.net/serotonin-syndrome-and-neuroleptic-malignant-syndrome-pearls-pitfalls/

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FOAM of the Week – EtCO2 in Cardiac Arrest, PCP Pneumonia, Guillain Barre, Lactate Clearance

By Eric Robert Deutsch MD in Airway, Cardiology, FOAM of the Week, Infectious Disease, Neurology, Pulmonology

As always, some great FOAM topics from this week’s lectures. Expand your knowledge…

Learn how to use End Tidal CO2 to improve your cardiopulmonary resuscitation: http://stemlynsblog.org/als-airway-breathing-c02/
Summary and various radiographic findings of PCP pneumonia: http://stemlynsblog.org/als-airway-breathing-c02/
A great summary of Guillain Barre from EMRAP: https://www.emrap.org/episode/april2006/guillainbarre
Thoughts from Weingart on lactate clearance: http://emcrit.org/wee/lactate-clearance-flawed/

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FOAM of the Week – Bougie Cric, DSI, Hyponatremia, Hyperkalemia, Ketamine

By Eric Robert Deutsch MD in Airway, Electrolytes, FOAM of the Week, Pharmacology

Lots of good stuff from this week’s lectures. FOAM away…

Bougie-guided cric: http://emcrit.org/procedures/bougie-aided-cric/
Management of acute hyponatremia from EMCrit: http://emcrit.org/podcasts/hyponatremia/
Kayexalate – it’s a bunch of crap (literally): http://rebelem.com/kayexalate-useful-treatment-hyperkalemia-emergency-department/
Delayed Sequence Intubation: http://emcrit.org/podcasts/dsi-update/
Ketamine, a great drug:
- http://blog.ercast.org/the-brain-on-ketamine/
- http://emupdates.com/2013/12/25/the-ketamine-brain-continuum/

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FOAM of the Week – Shoulder Dislocation, Knee Dislocation, Genitourinary Trauma

By Eric Robert Deutsch MD in FOAM of the Week, Orthopedics, Trauma, Urology

Thought I would share some trauma stuff that came up on recent shifts since it was class day today. Enjoy!

A newer technique for reduction of shoulder dislocations – haven’t tried it yet but looks super-easy: http://www.foamem.com/2013/06/25/trick-of-the-trade-got-a-shoulder-dislocation-park-it/
Knee dislocations – remember, >50% will spontaneously reduce upon presentation, so need to have a high index of suspicion, post from emDocs: http://www.emdocs.net/knee-dislocation-pearls-and-pitfalls/
Particularly in the obese, podcast from EMRAP: https://www.emrap.org/episode/march2015/obesepatientand/
Know how to work up your patient for genitourinary trauma? (Hint, the panscan is not sufficient) Check out these questions and answers from Life in the Fast Lane (and definitely read all the links to the Trauma Professional’s Blog for further details): http://lifeinthefastlane.com/trauma-tribulation-021/

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FOAM of the Week – Status Epilepticus, EMTALA

By Eric Robert Deutsch MD in FOAM of the Week, Neurology

Hope everyone had a great Thanksgiving and ate tons of turkey. Here’s a few things from lecture this week:

A podcast discussion on Status Epilepticus from EMCrit: http://emcrit.org/podcasts/status-epilepticus/
Or, if you prefer, a written summary from First10EM: http://first10em.com/2015/11/16/status-epilepticus/
A good overview of some things you need to know about EMTALA from EMRap earlier this year. Remember, most of us will be working at places that will need to be transferring patients to higher level of care, so this is good to know: https://www.emrap.org/episode/april2015/docinthebay

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FOAM of the Week – Back Pain

By Eric Robert Deutsch MD in FOAM of the Week, Orthopedics

This week’s FOAM of the Week is a pain in the back… *crickets chirp*

We see tons of back pain, most of which are benign, but a few can have serious etiologies. Listen to this EMRAP review to know what red flags to look out for: https://www.emrap.org/episode/november2013/mizuhoreviews
High risk causes of back pain from ALIEM:
- http://www.aliem.com/high-risk-back-pain-spinal-epidural-abscess/
- http://www.aliem.com/high-risk-back-pain-cauda-equina-syndrome-erem/
Do oral steroids work for benign back pain? http://coreem.net/journal-reviews/steroids-sciatica/

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FOAM of the Week – Nerve Blocks, Hip Dislocation, General Orthopedics

By Eric Deutsch in FOAM of the Week, Orthopedics

Some good MSK stuff this week to supplement our skills day. Enjoy

You learned the posterior tibial block to anesthetize the sole of the foot, now try some hand blocks:
Don’t sweat your hip reductions, try the Captain Morgan Technique:
- http://regionstraumapro.com/post/10201631357
- https://www.youtube.com/watch?v=lQMWaFX-MeQ
Question about something ortho related? A great comprehensive resource: http://www.orthobullets.com/

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FOAM of the Week – TXA in Trauma, Submassive PE

By Eric Deutsch in FOAM of the Week, Pharmacology, Pulmonology, Trauma

Since there was no formal lecture today, I’ve included a couple pieces related to issues that have come up on recent shifts. Enjoy!

TXA (tranexamic acid) in trauma – a nice review from emDocs. Of note, the reasons why you haven’t seen this given at Grady is because it’s stocked in the OR and the trauma teams (at least Emory) only give it when someone gets MTP. http://www.emdocs.net/txa-use-trauma-update/
Submassive PE – to lyse or not? A fantastic review from Pulmcrit that is absolutely worth the read: http://www.pulmcrit.org/2014/04/submassive-pe-do-we-have-it-backwards_18.html
What about catheter-directed tPA? http://rebelem.com/catheter-directed-thrombolysis-the-magic-bullet-for-submassive-pulmonary-embolism/

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FOAM of the Week 10/27/15 – Anticoagulation Reversal, Dental Trauma

By Eric Deutsch in FOAM of the Week, Hematology, Pharmacology, Trauma

Hey guys, I picked a few topics for this past week since we didn’t have conference. I think you’ll find them helpful – check it out.

One of the pharmacists was asking that I send some stuff out about PCC and anticoagulation reversal. I found a nice summary by Rob Orman from ERCast – it’s a few years old and some more evidence has come out since but it’s a good basis and more or less applies: http://blog.ercast.org/wp-content/uploads/2013/12/Anticoagulation-Reversal-Handout-12312013.pdf
Working trauma the other night I came across this dental trauma website that’s a great resource, so thought I’d share: http://www.dentaltraumaguide.org/

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FOAM of the Week 10/20/15 – Anaphylaxis, Pressors

By Eric Deutsch in Cardiology, FOAM of the Week, Immunology, Pharmacology

Some stuff related to this past week’s lectures (Sorry for the delay!)

Great overview of anaphylaxis management: http://first10em.com/2015/07/20/anaphylaxis/
Do steroids prevent biphasic reactions? http://rebelem.com/may-2015-rebelcast/#more-3788
Need to start that anaphylaxis (or otherwise hypotensive) patient on epi but can’t wait for the bag to make it up from pharmacy? Use push-dose pressors! Especially helpful if you go somewhere that doesn’t have excellent pharmacists and nurses like we have at Grady. http://emcrit.org/podcasts/bolus-dose-pressors/
And while we’re at it, what about giving that pressor through a peripheral line?http://rebelem.com/mythbuster-administration-of-vasopressors-through-peripheral-intravenous-access/

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