Dr. Mercer Wins AAEM Award
6 March 2014

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Congratulations to Las Vegas EM's own Meaghan Mercer, DO who was awarded the American Academy of Emergency Medicine's (AAEM) Resident of the Year Award for an emergency medicine resident who has made outstanding contributions to AAEM. Strong work Meaghan! Way to represent LVEMR! We are proud of you.

Match Day Coming!
2 February 2014

Well, we have finally completed interviews for the 2014 residency application cycle and we look forward to match day. To all of the applicants that visited us at UNSOM - we truly enjoyed getting to meet you! If you have any questions about our program, please spend some time on this website and do not hesitate to contact any of the faculty or residents for clarification. Try to RELAX as you make your rank list. Make the decision based on what is best for you and your family. You were all very qualified applicants and we know you will become great doctors wherever you land!

The Goodman Competition
EM2 Tony Zitek, MD takes 2nd place!

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On January 31, 2014 the University of Nevada School of Medicine held the 4th annual Philip H. Goodman Competition to recognize resident excellence in critical appraisal of a scientific paper. Dr. Zitek presented the paper "Targeted temperature management at 33C versus 36C after cardiac arrest" by Nielsen et al. which was published in the New England Journal of Medicine in December 2013.

He delivered a dynamic lecture and an outstanding analysis of the paper focusing on the strengths and weaknesses of the study as well as its implications for our emergency medicine practice. Great job Tony!

January S.O.T.M.
22 January 2014

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The Case:  A young patient with a history of thalassemia B presented to our emergency department with a sharp, pleuritic chest pain, lightheadedness, and shortness of breath. These symptoms had been present for 3 days.  She also had some heavy vaginal bleeding over the last 7 days. Her vital signs were T 98.3, HR 127, BP 112/73, RR 19, and O2 sat 88% RA.  Her exam was only remarkable for bilateral lower extremity edema and scant blood in the vaginal vault. Labs included Hgb 6.9, BNP 328, Trop 0.06, and Preg test negative.  Her EKG showed sinus tach and s1q3t3.  Her CXR was normal. Dr. Steve Elsbecker, and attending, Dr. Amy Urban, were concerned for a pulmonary embolism, so a CTA of the chest was ordered.  The CTA revealed extensive bilateral pulmonary emboli. The patient was given 2 units pRBCs and started on a heparin drip.  Dr. Elsbecker then performed a bedside echo and saw right heart dilation.  
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Dr. Elsbecker and Dr. Urban felt that this patient would benefit from thrombolytics, but they were concerned about giving systemic thrombolytics to a patient who has been having menorrhagia and who already had a hemoglobin of 6.9. They decided to call interventional radiology to arrange for a pulmonary angiogram and catheter-based t-PA.  Interventional radiology successfully performed catheter-based t-PA on this patient. She was then admitted to the ICU.  After about 24 hours in the ICU, she was downgraded, and shortly thereafter, she was discharged home.


Visit our FOAMed Blog Page for a more detailed description of the case with teaching point!

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.

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UPCOMING
GRAND ROUNDS SCHEDULE

2 April 2014
8:00a - Interesting Case - Dr. Kwak
8:30a - Reefer Madness - Dr. Zitek
9:00a - Communication in the ED - Dr. Baum
10:00a - Mechanical Ventilation & Noninvasive Ventilation - Dr. Pascoe
11:00a - Advanced OB/Gyn Ultrasound - Dr. Grace
12:00p - The Role of Gut Integrity in the Pathophysiology of Sepsis - Dr. Coopersmith

9 April 2014
7:00a - Peds Simulation (R1s) - Peds ED
8:00a - ACES - Dr. McCourt
9:00a - Pediatric Emergency Medicine - Dr. Nelson
10:00a - Good Samaritan Laws - Dr. Richardson
11:00a - Interesting Case - Dr. Lahham
11:30a - Interesting U/s Images - Drs. Beckmann, Eydelman, Pascoe, Tran, and Milligan

16 April 2014
8:00a - 1:00p - Mock Oral Boards

23 April 2014
8:00 - ENT Emergencies - Dr. McKinnon
9:00a - Pediatric EM - Dr. Nelson
10:00a - Research Lecture Series - Dr. Slattery
11:00a - Behavioral Emergencies - Dr. McCourt
12:00p - Evidence Based Approach to STDs - Dr. Cleveland

30 April 2014
7:00a - R2 EKG Test - Drs. Beckmann, Goshgarian, Galster, & Milligan
8:00a - ACES - Dr. Slattery
9:00a - The Crashing Cirrhotic - Dr. Kwak
10:00a - Diving Emergencies - Dr. Goshgarian
10:30a - Expert Case - Dr. Zitek
11:00a - EMS Topic - Dr. Bledsoe
12:00p - Interesting Case - Dr. Elsbecker
12:30p - Chemical Injuries - Dr. Healey