Click Here for new site!!!!

HEY Everybody. Thanks for stopping in. The Thomas Jefferson Emergency Residency page has a new home. It is a site run by the Residents and has tons of great new information. Head on over to http://jeffemres.googlepages.com/ for more info about the residency and to see the info we residents check on a regular basis.

new site

a new site is in the works. it's still in beta right now, but look for the link within the next week.

conference schedule: november 9th

07:00 medical malpractice by dr. mathew
08:00 pediatric joint conference: a case of miller fisher syndrome
09:00 monthly q&a with dr. gandhi and minczak
10:00 what's the diagnosis? by dr. minczak*
11:00 neurotrauma with dr. lopez


*the diagnosis was guillain-barre

congrats!

congratulations to charles and the wumbulwa family. charles is the proud father of a 7 pound 8 ounce girl. both mom and baby are healthy and doing well.

conference schedule: november 2nd

a new month with a new topic. november brings in the the nervous system.

07:00 neurology clinical cases with dr. hong
08:00 monthly ekg lecture with dr. zwanger
09:00 cranial nerve palsy/ peripheral neuropathy with dr. detiege
10:00 neuromuscular wekness by dr. seibert
11:00* neurology jeopardy wiht dr. riviello

*as an added bonus, university health will be around at 11 for flu shots.

pennsylvania license

for the third years:

here's a link to the pennsylvania state license site. you'll be referred to a usmle site where you'll need to pay $50 to have them send in your step scores. i'll post more as i get further through it.

pennsylvania license

for the third years, here's a link to the pennsylvania state license site. you'll be referred to a usmle site where you'll need to pay $50 to have them send in your step scores. i'll post more as i get further through it.

totally unrelated

this has nothing to do with emergency medicine, but it's been a long time since '82.

conference schedule: october 26th

a new lecture topic this week. anatomy and pathology with clinical correlation. should be interesting. let the chiefs know if you liked it. plus there's grand rounds this week, ...twice.

07:00: thoracic a & p with radiographic correlation dy dr. hector lopex
08:00: managment of COPD by dr. elijovich
09:00: monthly cord test - cardiovascular with dr. riviello
10:00: em grand rounds: generations at work
11:00: em grand rounds: intimate partner violence
- tracy g. sanson, md, facep, university of south florida em residency

conference schedule: october 19th

this week we have a special guest speaker, dr. mather of the jefferson heart failure serivce.

07:00: pneumonia and the 4 horus antibiotic rule with dr. s. brown
08:00: plain film x-ray review with the jefferson radiology bone fellow
09:00: journal club - see pulse for the articles (2 hours)
11:00: er management of chf with dr. vanderveldt and dr. mather

conference schedule: october 12th

back to the regular grind this week, but with a twist. this month's general focus is the chest.

07:00: toxicology: antidepressants by dr. kolecki
08:00: thoracic trauma by dr. vanderveldt
09:00: thoacic case review with dr. seibert (2 hours)
11:00: EM/IM joint conference - a review of the MAR/Admitting guidelines

conference schedule: october 5th

it's a special this week: third years are spending the day with dr. harris from our lady of lourdes learning about contract negotiation. ...pgy-1 and 2's, you're on your own.

pgy-1 only:
07:00: prescription writing/charting/orders
08:00: approach to chest pain and headache, both lectures by dr. doyle

pyg-1 & 2:
09:00: emergnecy medicine Q&A with dr. goldberg and dr. riviello
10:00: bioterrorism update with dr. jasper

resident retreat 2006

here's a few pics from the residency retreat this year down in avalon, new jersey. feel free to post some ones of your own.

conference schedule: august 31st

07:00 cardiac and aortic trauma by dr. adam brown
08:00 the patient with syncope by dr. scott brown (no relation)
09:00 an ebm approach to the treatment of pulmonary embolus &
10:00 cardiovascular case review - both by dr. ed seibert
11:00 monthly chapter review: trauma with dr. doyle

-gregg

conference schedule: august 24th

it's two hour lecture madness this week!

07:00 untitled lecture with dr. tom
08:00 2-hour journal club with drs. theiling, dang, and brown
10:00 em grand rounds*: marine envenomations by ACEP visiting speaker Dr. Frank Counselman

* grand rounds in herbut auditorium.

-gregg

conference schedule: august 17th

07:00 tick born illnesses with dr. neuberger
08:00 radiology conference by jefferson radiology
09:00 tox: anticholinergics by dr. kolecki
10:00 lmwh & 2b3a inhibitors in acs by dr. lopez
11:00 congestive heart failure by dr. brown


-gregg

conference schedule: august 10

07:00 cardiac biomarkers by dr. limkakeng
08:00 pediatric joint conference by drs. lau & lavelle
09:00 management of chest pain by dr. takakuwa
10:00 our lady of lourdes case conference with dr. al sacchetti
11:00 resident's only meeting with the chiefs.

-gregg

confernece schedule: august 3

07:00 approach to the trauma patient by dr. doyle
08:00 emergency medicine q&a with drs. minczak & brooks
09:00 ekgs with dr. zwanger
10:00 approach to the patient with a rash by dr. forstater
11:00 ed state of the art by dr. christopher


-gregg

conference schedule: july 27

back home in the usual college room.

07:00 multiple myeloma by dr. wayne lau
08:00 the patient with abdominal pain by dr. tim o'connor
09:00 resident's metting with the chiefs
10:00 journal club dr. tran, beams, & lau
11:00 grand rounds: wound closures and adhesives by dr. adam singer



-gregg

conference schedule: july 20

still exiled to 205 college.

07:00 crush injuries by dr. ken lavelle
08:00 radiology conference by the jefferson radiology fellow
09:00 CORD review "psychobehavioral" with dr. france doyle
10:00 toxicology "aspirin & non-steroidal agents" by dr. paul kolecki
11:00 ed procedures: epley maneuver and the tonapen by dr. mark zeitzer

here's a great demonstration of the epley maneuver.



-gregg

conference schedule: july 13

we're in 205 college this week.

07:00 radiology guidelines with dr. rex mathew
08:00 documentation by dr. ralph riviello
09:00 healthcare disparities by dr. ron hall
10:00 monthly ekg lecture by dr. mark zwanger
11:00 EM/IM joint conference on sepsis*

* joint conference as always will be in depalma hall.

-gregg

conference schedule: july 6

07:00 resuscitation update: review of new CPR guidelines by dr. ken lavelle
08:00 residency update by dr. bernie lopez
10:00 QA lecture dr. france doyle & dr. christine dang
11:00 pediatric cardiology by dr. dan minczak

-gregg

welcome interns

the interns are here and have begun working down in the emergency department. please welcome the jefferson class of 2009. best of luck.

-gregg

from the top left corner:

row 1: timberly booker, scott brown, jason theiling, emily chen
row 2: serge hougeir, timothy o'connor, adora ozumba, marleine shafik
row 3: matias elijovich, brian tran, charles wamublwa, lisa watts

conference schedule: june 29

just a note: conference will be held in 203 college this week.

07:00 emergency ultrasound by dr. seibert
08:00 the threat of nuclear terrorism with dr. jasper
09:00 "teaching residents to teach" by dr. griswold
10:00 toxicology: acetaminophen by dr. kolecki
11:00 grand rounds: diagnostic decision making in the ed by dr. nathan shapiro

congrats to the class of 2006

congratulations to the graduating class of 2006 and good luck as they start their new jobs. thanks for three great years.

Nelsson Becerrra, MD
ultrasound fellowship
St. Luke's/Roosevelt Hospital Center
New York City, NY

Lisa Evans, MD
St. Joseph's Hospital
Philadelphia, PA

Kathleen Hegarty, MD
Loyola University Medical Center
Maywood, IL

Jesse Iwanski, MD
INOVA/Mt. Vernon Hospital
Alexandria, VA

Hector Knox, MD
Doctor's Community Hospital
Seabrook, MD

Christopher Maurischat, MD
John T. Mather Memorial Hospital
Port Jefferson, NY

Alex Mohseni, MD
Prince William Hospital
Manassas, VA

Vishal Parikh, MD
Medical Associated/Community Health Network
Indianapolis, IN

Brian Rudick, MD, MBA
Venture Capital - Princeton, NJ
Pro-Temps, Philadelphia, PA

Trey Sims, MD
North Shore Medical Center
Miami, FL

Corey Waller, MD, MS
Spectrum Health Care
Ann Arbor, MI

McRae Williams, MD, PhD
Greater Baltimore Medical Center
Towson, MD

conference schedule: june 22

so i'm going to try and post the conference schedule every week. then, with the presenter's permission, tape and then link the mp3s to the blog. this week's line up:

07:00 trauma with dr. wayne bond lau
08:00 radiolgy by jefferson radiology
09:00 subarachnoid hemorrhage by dr. ray regan
10:00 rapid fire ECG's with dr. france doyle
11:00 pediatric upper extremity injuries by dr. alexander limkakeng

-gregg

new year

it's a new year at jeff and we're trying something different with the blog. hopefully we'll continue to add and improve it as the year goes on. feel free to post your comments and e-mail us with your suggestions, interesting cases, ekgs, photos, or whatever. ...good luck.

-gregg

Holiday Party, Dec 2, 2005!!!

more pics...

Holiday Party, Dec 2, 2005!!

Holiday Party, Dec 2, 2005!

Wow! What a great time!

Hypertensive Emergencies

Some handy tables from the AHA and American Stroke Association:

Lecture: Pediatric Respiratory Emergencies

Lecture by senior pediatric resident Dr. Andrew Meyer on Pediatric Respiratory Emergencies.

Pediatric Respiratory Emergencies

Lecture: Esophageal Disorders

Lecture by Dr. Ed Seibert on Esophageal Disorders. Click below to listen or subscribe to podcast on iTunes:

Esophageal Disorders

Lecture: HEENT Trauma

Lecture on HEENT Trauma by Dr. Ralph Riviello. Listen by clicking on link below or subscribing to podcast on iTunes:

HEENT Trauma

Lecture: Toxicology: Antipsychotics and Opioids

You can listen to Dr. Kolecki's lecture by clicking above or you may subscribe to our podcast by searching for "Jefferson" in iTunes under podcasts.

Antipsychotics and Opioids - Alex

CO Poisoning

That was a good case by Neil below.

A study in Annals showed that venous measurements of CO level accurately reflect arterial levels. Ann Emerg Med. 1995 Apr;25(4):481-3.

I will make the follow comments advocating arterial blood sample, though:

1. Few patients in the above study had high CO levels (>20%)
2. Pulse oximeter will give falsely elevated O2 sat values even in cases of extremely high COHb levels (Ann Emerg Med. 1994 Aug;24(2):252-5). In the setting of concomitant hypoxia (smoke inhalation), only an arterial sample will give an accurate measurement of arterial oxygen content when measured by lab CO-oxymetry Chest. 1998 Oct;114(4):1036-41.
3. ABG will allow evaluation for metabolic acidosis, which is very important, as several studies have shown that the degree of acidosis is a better predictor of severity than absolute CO level. J Accid Emerg Med. 1999 Mar;16(2):96-8 This is partially b/c CO also binds intracellular cytochromes needed for oxidative metabolism.
-Alex

CO Poisoning

Case Summary: A daughter, mother and grandaughter present to Jeff ED c/o nausea, lightheadedness, vomiting, and headache for several hours. The CO Monitor at home went off this afternoon s/p the furnace was turned on for the first time this morning.

DX: CO Poisoning

Plan:

1) Start pt on 100% High Flow Oxygen Mask.
2) Draw carboxy hemoglobin levels

Results/TX/What I learned:

The patients carboxy levels were elevated-- 10%, 22%, and 36% for D, Mom, and Grand Mom, respectively. CO levels can be elevated in smokers (10% is nml). CO has a half life of 4-8 hours. With high flow o2 mask, this half life is reduced to 60 mins. (with hyperbaric 02 chamber, halflife is reduced to 23 mins) Pts were left on mask for 2 hours, and then D/C'd. Common symptoms with CO exposure include lightheadedness, headaches, N/V. Blood venous PO2 measurements tend to be normal, because PO2 reflects O2 dissolved in blood and this process not affected by CO. In contrast, hemoglobin-bound O2 (which normally comprises 98 percent of arterial O2 content) is profoundly reduced in the presence of COHb. In this case, venous blood was sent.

Case: Opisthotonos

19 yo male presents with neck spasms, back spasms and trismus after ingesting several unknown pills 2 days ago and smoking crack today.
VS: HR 170's, BP: 150/100
PE: Young male in severe distress with neck and back in full extension, unable to relax muscles
ER course: Treated with IV ativan, benadryl and cogentin with full relief of symptoms
What we learned: Opisthotonos has a wide differential, including tetanus, dystonic reaction (from meds like compazine), intracranial hemorrhage, strychnine, meningitis.
-Neil and Alex

Class of 2007

What a fine looking cohort of folks. - wbl

Lecture: Seizures

Great lecture by Dr. Ray Regan on seizures in mp3 format. Download here or subscribe to our podcast to listen.

Seizures

-alex

... couple more from the retreat

Last Year's Retreat in ___ Baltimore

One of our yearly retreats... with some bystanders, including Harry Potter

Clonidine toxicity

I had an interesting case the other day: Young F on methadone presented with change in mental status, reported intake of 3 pills of clonidine.
VS: HR 35-40, BP 90/40, RR 11, POx normal, FS normal
PE: Depressed mental status but easily arousable by voice. However, pt's arousal was *very* transient. Mydriasis.
Our treatment: fluids, narcan (0.4), atropine (first 0.5, then 1mg), charcoal
ED course: pt became very agitated with the narcan, but hemodynamics did not improve until given the second dose of atropine and fluids.
What I learned: (From Ford: Clinical Toxicology, 1st ed)Clonidine toxicity can present similar to opioid toxicity : CNS depression, resp depression, miosis. Clonidine may also cause significant bradycardia and hypotension. The CNS depression from clonidine toxicity is unusual in that pts are easily arousable transiently (as soon as you stop stimulating them or talking to them, they can return quickly to a severely depressed MS); this can create problems if you try to intubate without full RSI meds, b/c they may wake up during the intubation. Also, pts may require significant amount of narcan (adults 1-2 mg / dose, up to 10mg). The rest of the treatment involves supportive care, atropine, charcoal, followed by dopamine if refractory bradycardia and/or hypotension.

-alex

Videos of ER procedures and splinting

"Emergency Medicine Education Online" has great videos of 1)Splinting 2) Life saving procedures like emergency thoracotomy, crich, central line placement...

EMEDU

ekg links

Some of my favorite articles on ekgs: (you can get the first 2 from MDConsult)

1. Additional electrocardiographic leads in the ED chest pain patient: right ventricular and posterior leads. Am J Emerg Med. 2003 Nov;21(7):563-73.
-(From our very own Amal Mattu)

2. Prominent R wave in lead V1: electrocardiographic differential diagnosis. Am J Emerg Med. 2001 Oct;19(6):504-13.
-(Again from Amal Mattu)

3. "Electrocardiographic Diagnosis of Acute Coronary Syndromes"

-alex

fun times...

dress code for the er...

holiday party pics

From our holiday party last winter... a good time was had by all.

intro

Welcome to the Thomas Jefferson Emergency Medicine Blog and Podcast site. Soon we will be hosting online audio podcasts of some of our weekly conference lectures for your enjoyment.

The Podcast will be hosted through the following feed: (cut paste this into iTunes [subscribe to podcast] or other podcast software)

http://feeds.feedburner.com/EML

Please email me at alex_mohseni@yahoo.com with any questions, comments or suggestions.

Please visit http://www.jefferson.edu/em/ to visit Jefferson's great Emergency Medicine program.

-Alex Mohseni (3rd year resident)