Conference Summaries

Conference Summary – January 21, 2021

Point of Care Echocardiograhy

Doctor performing an ultrasound on a man's chest
Top 3 Takeaways
  1. Point of care echo to estimate ejection fraction
    • Obtain parasternal long view
    • Criteria below suggest a normal ejection fraction
      • Anterior mitral valve leaflet (E point) approximates the septum
      • Myocardial thickening < 30% (IV septum or posterior wall)
      • LV cavity fractional shortening of > 50%
  2. Point of care echo in CPR
    • Don’t let US interfere with your compressions
    • Helpful to differentiate fine ventricular fibrillation from standstill
    • Informs adequacy of compressions. Don’t let maximal compression block the Left ventricular outflow tract (LVOT)
  3. Point of care echo to measure fluid responsiveness
    • Can measure stroke volume using LVOT VTI (Velocity Time Interval)
    • Measure LVOT diameter (normal 2cm)
    • Obtain apical 5 chamber view with pulse wave doppler over the LVOT
    • Trace one of the waves
    • Machine will calculate your SV
    • Normal VTI 18-22cm. Normal Stroke volume 55-100ml
    • Patient considered fluid responsive if > 12% increase after fluid bolus or straight leg raise test

Conference Summary – January 21, 2021

Synovial Analysis

Woman grabbing her knee in pain
Top 3 Takeaways
  1. Synovial analysis to know
    • WBC > 50,000 (+LR 4.7)
    • WBC > 100,000 (+LR 13.2)
    • Lactate > 10 mmol/l increase suspicion
    • Gm stain is poorly sensitive (Sn: 25-60%)
    • Culture is very important
  2. A gout or pseudo-gout joint can be septic!
    • Presence of crystals does not rule out infection
  3. Pearls
    • Have high index of suspicion for septic arthritis in immunocompromised (HIV, IVDA, chronically ill) or prosthetic joints. Synovial fluid may have lower WBC.
    • Exam, imaging, serum labs are of low utility. Get the synovial fluid.
    • If limited sample volume for testing, order of importance: Culture > Cell count > Gm stain > Crystals

Conference Summary – November 12, 2020

Headaches: It’s in the Details

Woman sitting at a laptop holding the sides of her head and cringing

Headache history taking and the migraine cocktail

Top 3 Takeaways
  1. Don’t ask, “Is this the worst headache of your life?” Instead, ask about onset, severity and quality compared to prior headaches. Knowing risk factors for secondary causes of headache will help differentiate the headache that needs work-up and treatment from the headache that needs treatment.
  2. Migraine cocktail should be evidence-based and tailored to the patient.
  3. Steroids may prevent bounce back and referral/education will certainly improve patient’s quality of life.