Stony Brook
EMergency Medicine
Residency

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101 Nicolls Road,

Stony Brook, NY 11794

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Copyright 2019 Designed by Michael Beck MD

The Best in FOAM Education

February Conference Pearls

February 28, 2018

We had another great month of conference in February leading up to the in-training exam today! Here are some pearls and follow-up resources from February 2018 EM Conference at Stony Brook.

 

M&M: Massive Pulmonary Embolism

-EMCrit Podcast 128: PE Treatment Options by Oren Friedman

https://emcrit.org/racc/pulmonary-embolism-treatment-team/

-EMCrit Podcast 143: Massive PE Hemodynamic Management by Oren Friedman

https://emcrit.org/racc/hemodynamic-management-massive-pulmonary-embolism-pe/

-PulmCrit posts:

https://emcrit.org/pulmcrit/thrombolysis-submassive-pe-alteplase/

https://emcrit.org/pulmcrit/ultrasound-assisted-thrombolysis-pulmonary-embolism-alteplase/

https://emcrit.org/pulmcrit/submassive-pe-peitho/

-Error of Omission vs Commission

     -EMCrit - https://emcrit.org/racc/motr-commission-and-omission/

     -PulmCrit - https://emcrit.org/pulmcrit/errors-of-commission-vs-errors-of-omission/

     -EMRAP Feb 2017 - Pelvic Fractures Part 1 - Chris Hicks - 9 min mark - When you encounter a really sick patient, it gives you the permission to act. You are only going to help the situation.

 

Grand Rounds: REBOA by Dr DuBose

-EMCrit Podcast 121: REBOA (intro to REBOA; note that this is before ER REBOA, so they talk about larger catheters):

https://emcrit.org/racc/reboa/

-EMCrit Podcast 170: ER REBOA with Dr DuBose:

https://emcrit.org/racc/er-reboa/

-ED ECMO for common femoral artery vs superficial femoral artery:

http://edecmo.org/logistics/ecpr/initial-cannulation/

 

 

PGY3 Senior Grand Rounds: Tamiflu by Dr Alexeeva

-Cochrane Review on Tamiflu (Oseltamivir)

http://www.cochrane.org/news/tamiflu-and-relenza-getting-full-evidence-picture

-CDC guidelines

https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm

 

 

Sim:

Case 1: Asthmatic arrest from tension pneumothorax

-Vent management for asthmatic:

     -https://emcrit.org/racc/vent-part-2/

 

Case 2: Refractory VF/VT with malfunctioning ICD

-Essentials of EMCrit talk by Dr Gray

-Don't be afraid to use the magnet if ICD overfiring

     -http://www.emdocs.net/pacemaker-and-aicd-management-in-the-emergency-department/

-ACLS fundamentals - early defibrillation, end tidal CO2 monitoring, etc; before going beyond ACLS, you must have the basics down cold

 

Central Lines:

-http://emcrit.org/central-lines/

-http://emcrit.org/podcasts/central-line-show/

-http://emcrit.org/podcasts/central-lines-placement-tips/

-http://emcrit.org/wee/central-line-micro-skills-deliberate-practice/

-https://emcrit.org/emcrit/microskills-dilation/

 

Chest Tubes:

-HIPPO Procedures: Tube Thoracostomy

-Note: you must confirm that chest tube is in the pleural space and not subcutaneous! Feel around the tube superiorly and inferiorly (feeling rib) as well as anteriorly and posteriorly (feel intercostal tissue), so the only place chest tube has gone is into the pleural space.

-EMRAP HD: Tips for Chest Tube Placement in Obese Patients

     -https://www.youtube.com/watch?v=dRogaMm0tbw

     -EMRAP Sept 2016: Trauma Surgeons Gone Wild: Chest Tubes in the Morbidly Obese

 

Knot Tying:

-One-handed square knot:

     -https://www.youtube.com/watch?v=uFJbTbjeU4Y

     -Crossing strands first can help the knot lay down flatter

-One-handed surgeon's knot:

     -https://www.youtube.com/watch?v=R4hZTyoGkco

 

Critical Care by Dr Weingart

Case - Awake Intubation:

-https://emcrit.org/pulmcrit/bipap-hfnc/

-https://emcrit.org/racc/awake-intubation-update/

-https://emcrit.org/racc/definitive-emergent-awake-intubation/

 

ECMO basics:

-ED ECMO Episode 2: 3 stages of ECPR

     -http://edecmo.org/three-stages-of-ecpr/

-Gauge to French conversion chart

     -http://www.harvardapparatus.co.uk/hapdfs/HAUK_DOCCAT_3/PY2_A_106.pdf

 

Interesting Case: Epigastric pain & dizzy -> ?Ductal Stone -> Cerebellar Mass by Dr Weiss

-Newman-toker DE, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc. 2007;82(11):1329-40. PMID 17976352

     -"Asked to choose the single best descriptor, 52% picked a different response on retest approximately 6 minutes later."

-Stanton VA, et al. Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians. Mayo Clin Proc. 2007;82(11):1319-28. PMID 17976351

-Newman-toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurol Clin. 2015;33(3):577-99, viii. PMID 26231273

-https://emcrit.org/racc/posterior-stroke/

-https://emcrit.org/emnerd/adventure-veiled-lodger/

-April 2017 EMRAP C3 (~90 min, but worth it!)

-EMRAP Sept 2017 HINTS by Evie Marcolini

     -"Posterior strokes are often missed in patients with GI symptoms of nausea, vomiting, and dizziness."

-Gait Examination - Stanford 25

     -https://www.youtube.com/watch?v=FFki8FtaByw

     -https://stanfordmedicine25.stanford.edu/the25/gait.html

 

Interesting Cases: Lactic Acidosis by Dr Coleman

-https://lifeinthefastlane.com/ccc/lactic-acidosis/

-EMCrit Acid Base series

     -https://emcrit.org/racc/acid-base-i/

-ICU Rounds Podcast: Type A and Type B Lactic Acidosis

     -http://burndoc.libsyn.com/webpage/2011/11

 

PGY2 EBM: Urinalysis by Dr Iyer

-EMRAP Jan 2016: The UTI That Isn't

 

Test-Taking Tips by Dr Mallon:
-https://www.youtube.com/watch?v=w5m9bXI3Dz0

 

CPC Intro by Dr Alian

-Here's an example of a case by Dr Alian:

     -Narang AT, Alian A. Clinicopathological conference: A 71-year-old female with neurological deficits, chest pain, and electrocardiographic changes. Acad Emerg Med. 2010;17(10):e102-9. PMID 21040102

     -http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2010.00877.x/full

-Our first sim in August (hypoxemia 2/2 sulfHb) with Dr Morley was based on a CPC case as well:

     -Sankoff J, Louie AD. Clinicopathologic conference: a 28-year-old woman with perioral cyanosis and low oxygen saturation. Acad Emerg Med. 2008;15(4):363-7. PMID 18370991

 

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