Here are the links to the videos/references from my Pigtail Lecture today:

•https://www.emrap.org/episode/pigtailchest/pigtailchest : This is EMRAP’s video that I showed in the lecture of Dr. Sachetti placing a pigtail in a patient.

https://vimeo.com/72761317 : This video is placement of the straight Cook catheter that we currently have.

https://emcrit.org/emcrit/pigtail-video/ : this is Dr. Weingart’s video of actual placement of a pigtail in a real patient

https://emcrit.org/emcrit/pigtails/ : this link is Dr. Weingart’s discussion of pigtails in general

So real quick, here’s 3 slides I found helpful from Dr. Camilo Castillo’s talk yesterday on spine injury. I’m sure there were others, but here’s 3. Obviously these are his, so if you steal these, please reference him.

In case any of you need a refresher on donning/doffing PPE, see videos below. The first is on normal PPE. Would recommend skipping to the 5 minute mark or so on the first one.

https://nam03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DbG6zISnenPg%26feature%3Dshare_email&data=02%7C01%7Cadam.ross%40louisville.edu%7Cb26b5cd106bc410bc36608d7ce7a6b82%7Cdd246e4a54344e158ae391ad9797b209%7C0%7C0%7C637204897498164783&sdata=src2WeSc06Os21NKeWiSnUC2U5u60ZSoJ37dIzHYNvo%3D&reserved=0

This video below is on the donning/doffing of PAPRs/hoods. We haven’t moved towards using these just yet, and I’ll provide some additional review/education/training in the near future, especially if we begin to push towards using them. Can skip to about the 4 minute mark on this one if you like.

First off, it’s not currently recommended to perform CT Chest on all suspected Covid patients.

If you’re doing a CT Chest for rule-out Covid-19 you must put this in the order comments/indication. If you’re scanning a patient who is under isolation precautions due to possible Covid, and order a CT PE Protocol, put Possible Covid, Rule-Out PE. The reason behind this is they’ll take the patient to the basement so that they don’t have to shut down the ED scanner. Thanks.

Wanted to post a couple links for Transvenous Pacemaker insertion. I think it’s mentioned in at least 1 or both, but the preferred site as Tej mentioned is either the right IJ or the Left IJ, followed by the right subclavian, and lastly the left subclavian (save the left subclavian so they can put a permanent pacemaker in here).

This one is unfortunately completely silent, but is annotated well and also has the exact type of pacemaker box we have in the ED (Bay 1, bottom shelf).

This is the one Tej showed by Jess Mason @ EM:RAP.

Good discussion from Steve Smith on T wave inversions: something we see a lot of. Check it out.

http://hqmeded-ecg.blogspot.com/2015/05/new-40-minute-lecture-on-t-wave.html

Quick read by Ryan Radecki on Medical Expulsion Therapy for Ureterolithiasis.

https://www.acepnow.com/article/medical-expulsive-therapy-no-longer-recommended-for-ureterolithiasis/?elq_mid=30116&elq_cid=10110279

All,

As promised during my lecture. See below for the links to the videos I referenced as well as a few others for joint reduction techniques. Hope these help. Also, I’m open to any feedback you have regarding the talk: things you liked, didn’t like, would like to see more of. Thanks.

https://www.youtube.com/watch?v=UxUhW4Zac74 Whistler Technique Hip Reduction Video

https://www.emrap.org/episode/reduction/reduction Multiple Techniques Hip Reduction

https://www.emrap.org/episode/hipreductionby/hipreductionby East Baltimore Lift- Hip

Larry Mellick Posterior Shoulder Reduction: https://www.youtube.com/watch?v=KRCqVekNEKc

Larry Mellick Inferior Shoulder Reduction https://www.youtube.com/watch?v=C8Irt39KBgk

Shorter version of Mellick’s Posterior Reduction w/o sound https://www.youtube.com/watch?v=MWb1OKkDDwE

Larry Mellick: 10 ways of reducing shoulder (10min) https://www.youtube.com/watch?v=HtOnreM7heg

Larry Mellick: Intra-articular injection/Ant Shoulder Reduction https://www.youtube.com/watch?v=HzROgg-HWPk

Larry Mellick: Davos Technique Shoulder Reduction https://www.youtube.com/watch?v=u2MsnjVNoPM

Jess Mason EMRAP: good explanation of Inf Shoulder Reduction https://www.youtube.com/watch?v=k_ORI51luFI

https://coreem.net/core/true-knee-patellar-dislocations/ Nice little summary on knee/patella dislocations

Larry Mellick Knee Dislocation: https://www.youtube.com/watch?v=aN7zDxtyHy8

Not Actual patients but good 2 minute video on techniques/exam: https://www.youtube.com/watch?v=vdrfY3K7yR4

https://www.youtube.com/watch?v=A91TWNbSEOQ – Silent Posterior Elbow Reduction Video

https://www.youtube.com/watch?v=IcrmMAxLnp8 – Interlocking Hands Technique for Posterior Reduction

https://www.youtube.com/watch?v=s9GVdF6v9xQ Posterior Elbow Reduction- 2 providers

Thought I’d post this. Saw it on Twitter. Cool little infographic on tox related syndromes.

As you may have heard recently, an outbreak of coagulopathy cases has occurred in the U.S., primarily in Illinois but also in other states (Indiana, Maryland, Missouri and Wisconsin), associated with synthetic cannabinoid (marijuana) use.  So far, there have been 94 cases nationally, with 2 deaths.

We have identified the first Kentucky case that appears to be linked to this outbreak. As per CDC, clinical signs of coagulopathy include “bruising, nosebleeds, bleeding gums, bleeding disproportionate to injury, vomiting blood, coughing up blood, blood in urine or stool, excessively heavy menstrual bleeding, back or flank pain, altered mental status, feeling faint or fainting, loss of consciousness, and collapse.”

Providers in Kentucky should maintain a high index of suspicion for vitamin K-dependent antagonist coagulopathy in patients presenting with clinical signs of coagulopathy, bleeding unrelated to an injury, or bleeding without another explanation and with a possible history of synthetic cannabinoids (e.g., K2, Spice, and AK47) use. These patients can be screened for coagulopathy by checking their coagulation profile (e.g., international normalized ratio (INR) and prothrombin time (PT)).

Should you see a patient exhibiting signs indicative of coagulopathy, call Poison Control at 1-800-222-1222 for diagnostic and clinical consultation and report the case to your local health department immediately.  For night and weekend public health case reporting, please call 1-888-9-REPORT(1-888-973-7678) for the Kentucky Department for Public Health’s Epidemiology On-Call Service.

These cases often require therapy with fresh frozen plasma and high doses of Vitamin K for extended periods (up to months) due to the long-acting nature of the poison.

Please see the CDC Health Alert at https://content.govdelivery.com/accounts/USCDC/bulletins/1e6dac3 for more information on the current outbreak.

Thank you for your attention to this emergent public health issue and for the hard work and diligence you exhibit every day in your clinical practice.

For additional information specific to this message, contact Doug Thoroughman, PhD, MS, CAPT, US Public Health Service, CDC Career Epidemiology Field Officer, Kentucky Department for Public Health at telephone: 502-564-3418 x4315 or email at douglas.thoroughman@ky.gov

Oral Risperidone is now in the Main ED Pyxis. It’s formulated as 1mg/1mL Vial for oral use. Usual dose is 1-2mg PO.

Couple things:
Cefazolin and Ceftriaxone will now (temporarily) only be in 2g Syringes in the ED Accudose machines due to fluid shortages.
Option 1: Just order 2g (while this may be more than necessary for some patients, there’s really no harm–renal patients if admitted would just have an interval adjustment).
Option 2: Order 1g, and wait for Pharmacy to tube up the 1g dose.

Unasyn is being pulled from the ED Accudose: you can still order, may just take a bit more time for pt to get as it will come from pharmacy.

IV fluids, Fentanyl, Morphine, Dilaudid are all on shortage. We have them, use them when appropriate, but consider oral fluids/pain meds if appropriate.

Let me know if you have questions/concerns. Thanks for reviewing. I’ll update you as things change/develop.

Ross

All,

Just a heads up, spoke with Hala Karnib, one of the Pulmonary Fellows and she requested if we have any lung masses (not just your basic pulmonary nodule repeat CT 3-6 months), that they be called and notified.
If these patients don’t require admission, they are able to and prefer to set them up for close follow up with Bronchoscopy, even within a couple days.
We had a patient yesterday who had been seen last summer in our ED for an unrelated complaint but ended up having a Lung Mass diagnosed; she was notified of this but didn’t really have follow up set up (though she had a PCP). This isn’t necessarily our fault, but had she been plugged into the Pulm system they would have contacted her to ensure she wasn’t lost to follow up (which she was and now presents with worsened metastatic cancer).
At least per her, they’d like to be called about these patients anytime. Thanks,

Ross