Grand Rounds: November 19, 2015

Lightninginjury-1200-80

After a week off for Essentials LA, we had an outstanding collection of presentations back at home. Dr. Jennifer Sayles of DHS gave a review of how payment policy is likely to change over the coming years, and Dr. Eiting introduced the topic of LGBTQ health in the emergency department. (Regrettably, because of a recording snafu, these talks are not available online — but the slides are available for current residents.) During the 2nd half of grand rounds, Dr. Preston presented tips and tricks for post-intubation sedation, and Dr. Paquette gave an overview of electrical and lightning injuries.

Spoiler alert!! After intubation, prioritize analgesia for your patient. Sedation should be a secondary consideration, as patients should be comfortable but not comatose when on the ventilator. Dr. Preston offers this tip, as well as many more, in his outstanding lecture on analgesia and sedation for intubated patients.

Dr. Paquette wows us as usual with an informative and hilarious overview of electrical and lightning injuries. Remember that, at the site of an active lightning strike, patients that are completely unresponsive should be the first priority. After a zap that can heat surface temperates up to 90,000 degrees Fahrenheit, a patient typically becomes asystolic and apneic. If rescue breathing is done, the SA node usually restarts and patients recover well. Check out the full presentation for many other awesome pearls!

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