November S.O.T.M
29 November 2013

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The Case: An elderly diabetic male presented to our emergency department with generalized weakness that had been progressive over the last 10 days.  The patient was unable to give any other specific complaints.  His exam was notable for tachycardia and suprapublic tenderness.  The finger stick glucose performed in triage was elevated.   

This patient was seen by 2nd year EM resident, Anna Healey, and attending, Jamie Baydoun.  They were concerned for DKA and possibly a UTI. They were not surprised to find that the patient had a UTI, and also had DKA with a glucose of 777, a bicarb of 12, and an anion gap of 18 and acute renal failure.

After receiving 2 L of saline, the patient had almost no urine output.  At this point, they decided to ultrasound his bladder and found what appeared to be a large bladder mass. The patient was then taken to IR for placement of emergent nephrostomy tubes. A follow up CT scan confirmed the bladder mass, and subsequent biopsy revealed a bladder sarcoma. 

Analysis: When a patient has DKA, we are taught to consider possible precipitating factors for the DKA.  In medical school, I was taught the three I’s --- insulin (noncompliance), infection, and infarction.  In this case, the underlying cause of this patient’s DKA was probably the bladder mass, which led to the UTI and systemic illness, making this a rare case in which cancer was the cause of the DKA.  This patient’s acute kidney injury and poor urine output led Dr. Healey and Dr. Baydoun to investigate him for urinary tract obstruction, which turned out to be the key to this case.  Their excellent care of this complex patient allowed for rapid diagnosis of this patient’s cancer, and this was the Save of the Month in our emergency department.

Las Vegas Marathon
19 November 2013

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On Sunday night Las Vegas EMR physicians provided medical support for the Las Vegas Marathon. We have provided this support for the past 7 years, under the direction of Christian Young, M.D. EM faculty and residents had the opportunity to serve as medical team volunteers in the on-site medical tents, where they provided immediate care to runners and determined whether transport to an emergency department was necessary. This is one of the largest marathons in the country and provides experience with the out-of-hospital management of a unique patient population.

In addition, 6 faculty members, 7 residents and many emergency nurses competed in the event this year!

A Glimpse at Orientation
13 November 2013

Lake Mead EMS Training
13 November 2013

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In Las Vegas we are lucky enough to be surrounded by many beautiful national parks including Zion, Grand Canyon, Death Valley and Lake Mead.  Keeping with our strong roots in event, wilderness, and EMS medicine we have created a relationship with the park medics and set up park medic refresher courses with all of these sights.  We not only provide medical service but also help teach others. 
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This week Emergency Medicine Residents Kellen Galster, Casey Fox, Meaghan Mercer, Anne Goshgarian, Walter Grenell, Mike Holtz, and Leon Eydelman created and taught a full day refresher course for Lake Mead park medics. Medic’s credentials ranged from EMS-B to Paramedics and we made sure to create scenarios that could tailor to all skillsets. 


Lake Mead was created in 1935 when the Hoover Dam was constructed and is located approximately 30 miles from the Las Vegas strip. Nearly 8 million people visit the recreational area every year to go boating, hiking, fishing, and to partake in other desert activities.

Life is Beautiful
27 October 2013

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The first ever "Life is Beautiful Festival" was held in Downtown Las Vegas October 26th and 27th.   Approximately 60,000 festival attendees enjoyed concerts as well as food, art and education booths. As with any event this large, emergency medical service was required. Overseen by our own Research Director David Slattery MD, Las Vegas Fire Department provided ALS support for the event. Along with the local fire department, Emergency Medicine Residents Chau Tran MD, Jeff Hall DO, Steve Elsbecker DO and Anne Goshgarian MD assisted with on-site medical care. Complaints ranged from syncope and chest pain to blunt trauma after large metal columns fell and struck two patients.

Overall though, the event was a huge success. Chefs, artists, educators and bands from all over the world converged on downtown Las Vegas. Alabama Shakes, Capital Cities, Childish Gambino, Zedd, Beck, Empire of the Sun, Kings of Leon, Passion Pit, Pretty Lights, and Vampire Weekend were among some of the bands playing for this year's crowd. Crowd favorites and local bands Imagine Dragons and The Killers drew huge audiences as well. 
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Event medicine is a huge part of what we do here in Las Vegas.  From weekend festivals like this to weeklong events like Burning Man, our program is actively involved in planning and providing medical services for participants.  It is one more way we can serve our community while practicing medicine in unique and challenging settings.

Be sure to come out next year for this incredible festival. Check out lifeisbeautifulfestival.com for details on next year's event schedule.  

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UPCOMING
GRAND ROUNDS SCHEDULE

27 November 2013
9:00a - Senior Res Research Presentations
10:00a - Pediatrics Lecture - Dr. Nelson
11:00a - Shoulder Reduction - Dr. Preddy
1:00p - Journal Club

4 December 2013
9:00a - Risk Management - Mark Hakim      
10:00a - ACES - Dr. Patel
11:00a - Pediatrics Topic - Dr. Nelson
1:00p - Core Content - Dr. Berkovits
2:00p - Child Abuse - Dr. Cetl

11 December 2013
9:00a - ACES - Dr. Carrison
10:00a - Child Abuse - Dr. Cetl
1:00p - Core Content - Dr. Hall
2:00p - Knee Injuries - Dr. Morgan

18 December 2013
8:00a - Pediatric Simulation - R3s (Peds ED)
9:00a - Journal Club
11:00a - Pediatric Topic - Dr. Nelson
1:00p - Radiation / Radiation Inj - Dr. Healey
2:00p - Vaginal Bleeding - Dr. Zitek