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Conference 3/19/2020

Conference on 3/19 will be our first trial attempt at the online/virtual conference model. The monthly topic is still pulmonary/critical care, so we will be sticking to ABEM’s model of clinical practice as much as we can during this virtual time. There is some asynchronous content for you below with some resources and procedural videos, in place of the simulation aspects we had to defer to round it out. We will still be doing the Zoom Conference sign in, so make sure to check your email for the meeting link.

BUT FIRST – Some bragging rights!

The EM crew, competitors and cheering squad
The competition team! From Left to Right – Dr Blustein (PGY2), Dr Scarborough (PGY2), Dr Willis (PGY2) and Dr Brewer (PGY2)

We had an amazing showing at the EMRA Quiz Show, with our team coming in second place! Very strong work by our rockstars from the PGY2 Class, couldn’t be more proud. We also had some amazing participatory efforts from several of our other residents in some of the competition games during the Quiz Show. It was quite a sight!

OK, Now onto business.

EMRAP has created some virtual conference of which the first iteration got released 3/18/2020.

EM:RAP Preselected Conference Content:

Feel free to check it out and review the virtual conference plan. Much thanks to EMRAP for keeping current. Much of the information centers around some respiratory updates and management of the ever present COVID-19.

Moving on – take a look at the asynchronous topics below and check them out as part of assigned readings for the week. These resources for reading below happen to come from EMDOCs http://www.emdocs.net/, which as you may know is a great FOAMed resource. All kudos/reference goes to the article authors. TL;DR summaries by S. Meyering DO FAAEM

Pulmonary hypertension and the crashing PulmHTN patient.

http://www.emdocs.net/the-crashing-pulmonary-hypertension-patient/
TL;DR version:

  • No consistent guidelines or standard of care exist for resus of pulmHTN patients
  • Bedside ECHO is key to evaluate cardiac wall motion and evaluate effusion or other causes of shock
  • you can cause rapid flash edema with aggressive IVF resuscitation – small bolus and infusions are key
  • Dobutamine and milrinone are key first and second line pressors in pulmHTN
  • optimize preload to enhance RCA perfusion
  • NIPPV is appropriate for LV failure patients or underlying pulmonary disease causes of pulmHTN
  • dysrhythmias respond better to cardioversion. Extreme caution for CCB or BB. Precipitate cardiogenic shock in these patients.

References:
Author: Erica M. Simon, DO, MHA (EM Resident Physician, SAUSHEC) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW Medical Center / Parkland Memorial Hospital) & Justin Bright, MD (@JBright2021)

Pulmonary abscess

http://www.emdocs.net/lung-abscess-pearls-and-pitfalls-to-consider-when-managing-patients/
TL;DR version:

  • Most common cause is aspiration, bugs therefore are multiple and likely have mixed flora and anaerobes. You need to cover with Something with anaerobic coverage (Clindamycin, Amp-sulbactam, Pip-Tazo, etc)
  • DM, alcoholics, poor oral hygiene, immunocompromised, CVA patients are all at risk. Aerobic bacteria are more prevalent in immunosuppressed.
  • CT imaging modality of choice –> More sensitive than CXR
  • Board question for etoh is Klebisella.
  • Blood cultures for pulm abscess are rarely ever positive.

References:
Authors: Mark M. Ramzy, DO, EMT-P (@MRamzyDO, Emergency Medicine Resident at Drexel University, Department of Emergency Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

Now onto the procedure videos.

I think some of the highest yield/lowest frequency thoracic procedures are those of critical management. Chest tubes, Thal or pigtail tubes, Circulating volume for temperature resus, Needle cric for pediatrics, Cric for adults, Thoracotomy. Below are some videos of these. All credit is due to authors of the videos – EMRAP, EMCRIT, EssentialsOfEM, MedScape. All content shared here is FOAMed.

https://www.youtube.com/watch?v=9eljF9eIKtc

Thanks for checking out the articles and video. Stay tuned for live virtual conference the morning of 3/19.

Photo credits:

K. Holmes DO FACEP
S. Meyering DO FAAEM

Stefan Meyering DO, FAAEM, FACEP

Dad, Academic EM Attending Physician, Fish Nerd & Backyard Mechanic | APD @ Ft Worth EM | Interests: Graduate Medical Education, Risk Management and Legal Medicine, POCUS, Free Open Access Medical Education (FOAMed), Physician Wellness

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