Vasopressors
We’ll review the pharmacology of commonly used vasopressors and inotropes and how this applies to your crashing patient. We’ll also review the literature and any guidelines available with respect to selecting the most appropriate agent based on specific clinical scenarios.
Learning Objectives
Review the basic pharmacology of specific vasopressors and inotropes
Vasopressor choice based on clinical scenario
Review up to date guidelines
Pearls
When in doubt- start norepinephrine!
What’s the heart doing? consider an inotrope for poor LV contractility on POCUS
Let the patient’s physiologic and hemodynamic response guide you (re-examine and re-evaluate!)
Dermatologic Emergencies
No longer be stumped by rashes! This talk will equip you with an approach to common rashes and the terminology to speak to consultants.
Learning Objectives
Classify rashes to one of four categories
Identify non-anaphylaxis drug rashes
Pearls
There are 4 classifications of rashes: maculopapular, erythema, petechiae/purpura and vesiculobullous.
There are several non-anaphylaxis drug rashes -SJS, DRESS, AGEP and erythroderma.
Urologic Emergencies
Geriatric Pearls
Older people are probably the most complex patients in the ED. This talk will introduce a 5M model to organize your approach – mentation, medication, mobility, multicomplexity, and what matters most. Plus a few simple strategies to make your assessment simpler and more effective. You’ll be not just good, but great, at managing older patients.
Learning Objectives
To describe three main components of a geriatric assessment to ensure a durable discharge
To list the components of delirium, mobility, function, and frailty
To add three strategies to their next encounter with an older person
Pearls
Sit down. Talk slowly not loudly. Go for a walk.
Frailty is a thing: learn a tool to identify it and measure it.
Delirium looks different in older people: think of “resting peacefully” as a symptom.
Its more than a feeling…….
Acute aortic syndrome is a life threatening emergency that we consider in anyone presenting with chest pain. The miss rate is quoted as 1 in 3, and the mortality rises per hour all the way to 90%, but it’s rare and can mimic more common condition such as acute coronary syndrome, pulmonary embolism or stroke. So who should you investigate? Who should you transfer for a CT to rule out AAS? Which patients should you be calling the Surgeon directly? What if they can’t be transported now? How do you manage while the weather is clearing? This talk is designed to be practical, recommendations will be given based on the current evidence, and at the end of the talk you will feel confident answering all of these questions!
Learning Objectives
Understand the important signs and symptoms that are associated with aortic dissection.
Apply these clinical findings to establish a pre test probability.
Decide who needs advanced imaging.
Pearls
Consider AAS in anyone presenting with symptoms consistent with AAS who are >50 or have abrupt onset pain or severe pain AND no proven alternative diagnosis*
Ask and document high risk pain features( AORTA – Abrupt Onset,Raditating/migrating,Tearing,Absolute worst pain ever) associated with AAS
Mortality rises at a rate of 0.2%/hr, in a stable patient if an alternative diagnosis is more likely you have time to work up your patient
Hip Dislocation
Stop standing on the bed and learn how to easily reduce hip dislocations without hurting your back. This session will review several hip reduction techniques and strategies to increase your success.
Learning Objectives
Describe how to perform the East Baltimore lift technique.
Describe how to perform the Captain Morgan technique.
Describe how to perform the Rocket Launcher technique.
Pearls
Ensure that you have adequate analgesia and consider nerve blocks.
Utilize your legs and gravity, rather than your back, when performing hip reductions.
Avoid excess traction on the knee when performing hip reductions.
Cirrhosis
Withdrawal
To discuss the basic pathophysiology of alcohol withdrawal, review the different clinical presentations, and formulate a management plan for patients who present in alcohol withdrawal to the ED.
Learning Objectives
To review the pathophysiology of alcohol withdrawal
To be able to recognize the clinical presentation of alcohol withdrawal
To formulate a management plan for patients in alcohol withdrawal
Pearls
Alcohol withdrawal is due to an imbalance in the CNS of excitatory and inhibitory tone
The different clinical presentations of alcohol withdrawal are not linear
Your first line treatment is to enhance inhibitory tone with benzodiazepines, manage and co-existing medical complications, and address nutritional deficiencies.