Sepsis
The pendulum on sepsis management keeps shifting. Learn the latest evidence and guideline recommendations for sepsis care in the Emergency Department.
Learning Objectives
Describe an approach to managing the septic patient in the ED
Appraise the latest sepsis management evidence
Describe the utility of point-of-care ultrasound to help guide ongoing sepsis management
Pearls
Check your patient’s past culture data to appropriately tailor antibiotics for them
After a 30cc/kg bolus of crystalloid, further fluid management requires re-assessment
Norepinephrine remains the first-line vasopressor in patients with septic shock
Obstetrical Emergencies
A labouring patient arrives in your ED. The baby is crowning and there is no time for OB to arrive. Join me for a review and update on managing selected obstetrical emergencies in the ED to lower your fears and improve your confidence and competence.
Learning Objectives
Describe unique considerations to managing obstetrical deliveries in the ED
Demonstrate 3 maneuvers to manage shoulder dystocia
Discuss an approach to the assessment and treatment of post-partum hemorrhage
Pearls
If you don’t have a delivery bag at your triage desk, get one (and put a flashlight in it).
When clamping and cutting the umbilical cord, allow a little extra length in case umbilical access is required.
Hyperflexion of the legs combined with suprapubic pressure will relieve most shoulder dystocias
Right Ventricular Failure
This talk will provide an approach to the Emergency Department management of decompensated pulmonary hypertension. It will review cardiopulmonary physiology. Finally, the talk will feature a discussion of common precipitants of right ventricular failure in the patient with pulmonary hypertension and how to mitigate the domino effect of insults to pulmonary circulation that have the potential to culminate in cardiovascular collapse.
Learning Objectives
Consider pulmonary hypertension in the differential diagnosis for a patient with dyspnea
Review the anatomy and physiology of the pulmonary circulation
Understand common precipitants of acute right ventricular failure in patients with pulmonary hypertension and how to avoid them
Pearls
The right and left ventricles are affected differently by positive pressure ventilation, which reduces left ventricular afterload, but increases right ventricular afterload and can be dangerous in acute right ventricular failure.
Use point of care ultrasound to guide the management of hemodynamic compromise in patients with pulmonary hypertension
Tachycardia, hypoxia, acidemia, hypo and hypervolemia all worsen the vicious cycle of right ventricular failure. Carefully optimize these parameters to stop the cycle.
Pediatrics
Vomiting is a very common chief complaint in infants seen in the ED and a source of anxiety for many parents. While it is often due to a viral infection, EM providers need to maintain a broad differential and consider serious and surgical causes of vomiting when assessing these infants.
Learning Objectives
Consider a broad differential for vomiting in infants
Use key historical and physical examination findings to hone in on the correct diagnosis
Outline the stabilization and workup required when infantile vomiting may be due to a surgical emergency
Pearls
All that vomits is not gastro.
Bilious emesis in babies can be yellow. Anything other than milk coming back up should give you pause.
No diarrhea = No gastroenteritis (yet).
Vertigo
Why we dislike vertigo, and how to learn to love it
For decades, emergency physicians have been taught vertigo approaches which made it difficult to make a diagnosis. Dr. Johns will demonstrate how you can reliably identify most causes of vertigo utilizing evidence based bedside testing and appropriate hi
Learning Objectives
Recognize the short-comings in traditional approaches to vertigo
Identify which patients are appropriate for Dix-Hallpike OR HINTS exam.
State the diagnostic criteria for vestibular migraine.
Pearls
By reliably diagnosing a benign cause of vertigo, you rule out a central cause
Only perform Dix-Hallpike test if no spontaneous nystagmus. Only perform HINTS if there is spontaneous nystagmus.
With a good history you can diagnose vestibular migraine very commonly.
Sports Medicine
Learning Objectives
Review the assessment and management of common soft tissue injuries of the upper and lower extremity commonly seen in the ED
Develop an awareness of easily missed injuries of the wrist
Identify medical issues related to atheltes that may present to the ED
Endocarditis will #%?&$ You Up
Endocarditis from the ED perspective. A diagnosis we rarely suspect and make. Time to change
Learning Objectives
Know who to suspect
Know how to take an endo hx and px
Know what to do when endo falls onto your lap
Pearls
Blood culture gospel
Antibiotics
Fever plus one
Skin and Soft Tissue Infections
Skin and soft tissue infections are common ED presentations. This talk will cover best practices for treating these infections.
Learning Objectives
What is the evidence for packing wound abscesses?
Do I prescribe antibiotics for wound abscesses? If so, which agents?
Should I start my patient on oral or IV antibiotics?
Pearls
There is no evidence that packing improves outcomes following abscess I&D
Antibiotics are a good idea if the patient has MRSA risk factors or significant surrounding cellulitis. Septra is better than clindamycin.
Oral antibiotics should be used most of the time. IV antibiotics are only indicated for patients that are: systemically unwell, vomiting, or have a malabsorption syndrome
SVT in WPG
Conduction in SVT is a lot like getting lost in a city with really poor, confusing roads, bad drivers, and bridges…not that I’m thinking of any city in particular.
Learning Objectives
Explain the pathophysiology of various types of SVT in simple terms.
Identify different types of SVT using tools available in the ED.
Describe treatments for SVT other than adenosine.
Pearls
SVT is an opportunity to describe and teach electrophysiology and EKG skills to your learners.
Careful attention to certain identifiable signs in ED patients with SVT may help out your electrophysiologist.
SVT can be treated in a more elegant way than the simple “turn it off and turn it back on again” approach.