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EDU Follow Up

Pulmonary

We had a thick conference the past two weeks. If you had a desire to follow up on some of the topics we covered, below we have continued content on vent management, awake intubations, and the pharm. lecture on abx. There’s a lot to learn out there people, enjoy!

Vent Management Lecture Series: Dr. Shanawani

part 1
part 2

Awake Intubations

Dr. George Kovacs does what he does best

Pharmacy ID ABX

Rachel Wein breaks down abx

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Week 7: Pneumonia, TB, pleural diseases, and PE

You have 10 minutes to answer 10 questions

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We continue to FLIP this week with Drs. Bajkowski, Bedford, and Dikeman. We will be covering pneumonia, TB, pleural diseases, and PEs with a mix of stations and procedures! Be sure to watch or read about how to do a thoracentesis so that you can get the most out of Dr. Dikeman’s station.

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Interested in a diagram on PEs for pregnant and non-pregnant patients? Here you go.

EMDocs on a TB case

Pediatric Chest Tubes/Pigtails and Pleural Disease

Radiopedia has a good review of CXR and CTs of pneumoconiosis.

EBMedicine’s Community Acquired Pneumonia and their CAP Recap

Sonosite US guided thoracentesis
Sonosite Byte Cases

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Harwood and Nuss Chapter 74 Pneumonia
Harwood and Nuss Chapter 75 Pleural Effusion
Harwood and Nuss Chapter 79 Pulmonary Embolus
Harwood and Nuss Chapter 80 Hemoptysis
Harwood and Nuss Chapter 188 Tuberculosis
Harwood and Nuss Chapter 265 Pneumonia (pediatric)

OR

Rosen’s Chapter 76 Pneumonia and corresponding Crackcast
Rosen’s Chapter 77 Pleural Disease and corresponding Crackcast
Rosen’s Chaprer 135 Tuberculosis and corresponding Crackcast

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Week 6: Pulmonary Part 1

You have 10 minutes to answer 10 questions

This week we start up part 1 of our 2 part series on everything respiratory, focusing on obstructive/restrictive lung diseases, as well as the finer points of vent. management, RSI, airway adjuncts, and NPPV. We will be collaborating with both the MICU and our very own ED RTs, who will be joining us to share their wisdom, so come hungry for that knowledge as Drs. Melhem, Buscarino, and Wong get their FLIP on. Note that there will be hands-on practice with the vent and NPPV, we have REQUIRED content below to help you brush up on your skills. Otherwise, stick to your own study plan and enjoy the shmattering of readings below. Read up, come prepared, and as always…

*Required Material*

Please review the below EMcrit Vodcasts. While Dr. Weingart’s lectures are often controversial, this is an excellent review on vent. management.
dominating the vent pt 1
dominating the vent pt 2

Core Content: Harwood & Nuss

Core Content: Rosen’s

Supplementary MATERIAL

EBM:
Vent Management
Asthma
COPD
NPPV

EM RAP:
C3 Airway pt 1
C3 Airway pt 2

EMCrit Podcasts:
BVM
The Crashing Asthmatic
Post intubation sedation
DSI
Awake Intubation w/ George Kovacs

REBEL EM:
The HOp Killers! ***I highly recommend this series

CRACKCAST:
Chapter 73 – Asthma
Chapter 74 – Chronic Obstructive Pulmonary Disease

EM BASIC:
Airway
Airway pt 2
NPPV

Other:
RSI review
Core EM, post intubation sedation
Core EM, advanced RSI

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Week 5: Psychiatric Emergencies

You have 10 minutes to answer 10 questions

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Heading into the world of Crisis. We’ve got another round of psych FLIPs this week done by Drs. McElroy, Moore, and Praamsma. We will be covering personality disorders, mood disorders, violent patients, including how to properly put on restraints. This will be followed by a FUR by Dr. McRae.

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Rosen’s Chapter 110 Thought Disorders
Rosen’s Chapter 111 Mood Disorders
Rosen’s Chapter 112 Anxiety Disorders
Rosen’s Chapter 113 Somatoform Disorders
Rosen’s Chapter 114 Factitious Disorders and Malingering
Rosen’s Chapter 115 Suicide

OR

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ED Approach to Agitation

emDocs Cases: ED Approach to Agitation

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EDU Follow Up Journal Club

JC: HFNC

Journal Club: High Flow Nasal Cannula

Hey Everyone! As the new interns settle in, we don’t want new education falling behind. Some of you may have celebrated at Dubey’s pool party, but little did you know there was a club within the party…a JOURNAL CLUB. If you missed out on it, Dr. Maqbool discussed the benefits of high flow nasal cannula (something we see everyday at CHM but RARELY at DRH). See below for the recap!

Clinical Vignette: A 55 year old male with a history of Type II diabetes and hypertension presents to the emergency department with a chief complaint of “I’m having trouble breathing.” Patient states that for the past two days, he has felt increasingly short of breath. He denies any fever, cough, rhinorrhea, or chest pain. He is tachypneic and lungs are clear to auscultation. Initial vitals are blood pressure 180/76, HR 94, RR 24, SpO2 is 91% on room air. You are concerned about the patient’s respiratory distress but don’t think the patient warrants intubation because he is alert, has no accessory muscle use, and is able to speak to you in full sentences. However, you want to address the patient’s tachypnea and hypoxia. You wonder which intervention will help prevent your patient from being intubated in the ED today and also provide the greatest long term benefit for his respiratory status. What will you use for oxygen therapy? Standard O2 nasal cannula or high flow nasal cannula? What would you use if the patient had COPD? What if the patient had fevers or signs of pneumonia? What if the patient presented with signs of pulmonary edema or heart failure?

Click here for the response to the vignette!
Click here for all the articles!

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Week 50: Dermatology Part 2

You have 10 minutes to answer 10 questions

This week we will conclude our dermatology block. These are all board relevant topics, and chief complaints we see almost daily! Not the most exciting topic, but it’s bread and butter baby. We will kick things off with FLIP hosted by Drs. Padgett and Darr. For this week focus on non-infectious dermatologic pathology and pediatric rashes. Also, if you didn’t know, we have online access to Rosen’s! If you prefer their exhaustively detailed approach to core content, then feel free to use it as your main source, but we still primarily advocate for Harwood & Nuss. See the link below, you will have to use your Wayne State login to access it (if you don’t have this e-mail Gloria).

TEXT: Harwood & Nuss

TEXT: Rosen’s

Chapter 110: Derm. Presentations

ONLINE MATERIAL

EBM comprehensive review on pediatric rashes:
Part 1
Part 2

Rash Algorithms:
LITFL
WikiEM

Podcasts:
CoreEM: SJS/TEN
Crackcast: Derm. Presentations

Categories
EDU Follow Up Journal Club

JC: RSI in TBI & Derm

Journal Club: RSI in TBI

If you missed Dr. Neha Mehta-Sykes’s JC on this topic, make sure to read the review posted below. Our choice of paralytics in these patients often causes a stur amongst our NICU colleagues, so educate yourself!

Clinical Vignette: 70 yo M with PMH of HTN, non-compliant with HCTZ and amlodipine, presenting with new-onset seizure x2 witnessed by family, followed by altered mentation. EMS was called by family. Presenting vital signs are: BP 225/135, HR 120, RR 12, pulse ox 95% on non-rebreather mask, temp 37.3. GCS 5, responsive to pain in all extremities except for right upper, with right eye gaze deviation. The decision is made to intubate the patient for airway protection. You suspect an intracranial hemorrhage as the cause of his seizures. Which medications would you like to use to intubate the patient?

Click here for the review and musings on the topic!
Click here for all the articles!

Think Pair & Share: Abscess/Cellulitis

We had our first ever Think Pair & Share FLIP this week! Big shout out to Drs. Messman, Kava, and Burkholder for paving the way for this. We hope to integrate more true FLIPs such as this into our conferences. These are discussion based small groups, so I’m sure every group had a slightly different experience. See the full literature review below if you wanted to revisit any of the topics.

Click here for the deepest of dives

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Week 49: Dermatology part 1

You have 10 minutes to answer 10 questions

This week will mark part 1 of our 2 part series on dermatology. This week we will focus on all things infectious. This block will have a lot of cross talk between previous conferences as there are many sources of skin/soft tissue infections we’ve previously covered (ticks, other parasites, bacteria, fungi). Drs. Franckowiak and Inman will be hosting FLIPS on common infections as well as scratching the surface of some zebras

We will also be starting a new series of deep dives. We will have a “Think Pair & Share” station hosted by Dr. Messman and VandenBerg. This will be a true FLIP, and you have required readings posted below. You MUST do the readings for this station.

*Required Readings*

EBM MRSA
Talan et al. 2016
Singer et al. 2014 SSTi treatment review

TEXT: Harwood & Nuss

Chapter 147: Hand Infections
Chapter 180: Skin and Soft Tissue Infections 
Chapter 181: Tetanus 
Chapter 273: Foreign Bodies
Chapter 277: Cellulitis
Chapter 374: Insect, Tick, and Mite Bites and Infestations 
Chapter 375: Mammalian Bites and Associated Infections 

TEXT: Rosen’s

Chapter 60: Foreign Bodies
Chapter 61: Mammalian Bites
Chapter 137: Skin and Soft Tissue Infections

ONLINE MATERIAL

Misc.
CoreEM-cellulitis
REBEL EM: abscess and abx
REBEL EM: abscess mgmt
REBEL EM: cellulitis snd abx
Canadiem chalk-talk: SST infxn

EBM:
SST infxn: the common, the rare, and the deadly
Pediatric SST infxn

Podcasts:
Crackcast: skin and soft tissue infections
EMRAP: SST infection 1
EMRAP: SST infection 2


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Week 48: SONOCUP

This week we have a very special conference, SONOCUP! There will be no quiz, but below are some good US review resources so that we can all bring our A game. And for those of you wanting a quick review of the basics without getting too fancy you can also look at the “Ultrasound Rotation” portion of the resident handbook which has a great breakdown provided by the amazing Dr. Baker. There is also a list of great US texts at the bottom of the handbook page if you have not found one that you prefer yet.

Don’t even know which knob is which? Start here.

A few more basics:

Abdominal Aortic Aneurysm
Deep Vein Thrombosis
Inferior Vena Cava
Aortic Dissection
EFAST
Hydronephrosis
Tamponade
Pulmonary Embolus

There are many, many more videos on the website (shoulder dislocations, nerve blocks, SBO, etc) so be sure to look around if you have any topics you’ve been interested in learning about!


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Week 46: Psych: Substance Abuse

You have 10 minutes to answer 10 questions

Welcome back everybody! This week we will be covering substance abuse and their psychiatric manifestations, so it’s time to get down with the DTs, brush off those bugs crawling on your skin, wave hello to that friendly pink elephant in the corner, and remember the answer is ALWAYS benzos. FLIP will be hosted this week by Drs. Koripella and Wilson. There are a lot of small topics to cover, we will focus on ETOH/withdrawal, stimulants, hallucinogens, opioids, and antichol/cholinergics, so choose one source and do your best to hit the highlights. We have recruited the tox. folk to help out with the stations so bring your A game!

TEXT

Chapter 297: Ethanol 
Chapter 298: Ethanol Withdrawal 
Chapter 305: Opioids 
Chapter 343: Serotonin Re-uptake Inhibitors and the Serotonin
Syndrome
Chapter 344: Anticholinergic Agents 
Chapter 345: Cocaine
Chapter 346: Hallucinogens
Chapter 348: Amphetamines and Stimulants

ONLINE MATERIAL

EMRAP
ETOH Withdrawal
Sympathomimetics
Serotonin Syndrome

FOAMCast
Anticholinergic and Physostigmine
UDS, Cocaine, PCP
Alcohol Withdrawal

OTHER
EMCases – EToH Withdrawal (good FOAM comprehensive overview)

ARTICLES
EBM – Drugs of Abuse

DEEP DIVES
EMCrit: Phenobarb mono-therapy in alcohol withdrawal

ROSENS TEXT
154. Cocaine and Other Sympathomimetics
156. Hallucinogens
150. Anticholinergics
185. Alcohol-Related Disease