Author Archive for: srrezaie

R.E.B.E.L. ECG of the Week: Wellens’ Syndrome or STEMI

14 Aug
August 14, 2014

Wellens' Syndrome or STEMI

A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.

According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation.  She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest.  Today she awoke with substernal chest pain that never resolved and continued in the emergency department.  She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.

BP 127/89     HR 76     RR 20      O2 sat 100% on 2L NC     Temp 99.3

Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
CTA B
2+ pulses in her extremities, no edema

ECG is shown (No prior ECG for comparison)…..

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REBELCast August 2014

04 Aug
August 4, 2014

REBELCast LogoWelcome to REBELCast August 2014, where Matt, Swami, and I are going to tackle a couple more scenarios to help your clinical practice. Today, we are going to specifically tackle two different topics:

Topic #1: Significance of Isolated Vomiting in Pediatric Minor Head Trauma
Topic #2: Early Detection of Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department Read more →

Update on Age-Adjusted D-Dimer

11 Jul
July 11, 2014

Update on Age-Adjusted D-DimerD-dimer has been shown to increase with age, which can cause a lower specificity (i.e. more false positive tests) in older patients. The result of this would be that older patients would often have more diagnostic imaging or downstream testing, but on the other hand, maybe a higher cut-off d-dimer value may lead to increased false negative cases (i.e. missed venothromboembolism) and make this strategy less safe. Recently, I wrote a post on age-adjusted d-dimer testing on REBEL EM, but since that post there was a new article that was published in Chest 2014. This post, will specifically focus on an update of age-adjusted d-dimer testing based on the above article. Read more →

REBELCast Episode 1

01 Jul
July 1, 2014

REBELCast LogoWelcome to REBELCast Episode 1, where Matt, Swami, and I are going to tackle a couple of scenarios to help your clinical practice.  Today, we are going to specifically tackle two different topics:

  • Topic #1: Clinically Important Biphasic Anaphylaxis
  • Topic #2: Total Lymphocyte Count (TLC) as a Surrogate Marker for CD4 Counts

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Introduction of REBEL Cast

19 Jun
June 19, 2014

REBEL Cast LogoFor those who haven’t checked out the site already R.E.B.E.L. EM stands for Rezaie’s Evidence Based Evaluation of Literature in Emergency Medicine. The blog was launched in October 2013, and continues to grow every month, and with that growth we are excited to announce the introduction of REBEL Cast.  Read more →

Critical Care Horizons

11 Jun
June 11, 2014

Critical Care Horizones

Please welcome a new development in critical care publishing with the launch of a new open access critical care journal: CRITICAL CARE HORIZONS!!!  This will be a fresh, new, original voice in the critical care literature, offering thought provoking, cutting-edge commentary, opinion papers, plus state-of-the art review articles. Read more →

R.E.B.E.L. ECG of the Week: LBBB and STEMI

09 Jun
June 9, 2014

R.E.B.E.L. ECG of the Week

89 year old male with PMH of hypertension, stage 3 chronic kidney disease with chief complaint of shortness of breath. Several days ago patient had a laminectomy for radicular pain. He was doing fine post-operatively and began to develop gradual shortness of breath.  He had no complaints of chest pain, nausea/vomiting, fevers, diaphoresis, but did have some weakness.  There were no prior ECGs for comparison.

BP: 98/48 HR: 103 RR: 18 O2 on RA: 94% Temp: 38.6

JVD to the angle of the mandible
Bibasilar Crackles
Sinus Tachycardia
Bilateral lower extremity pitting edema

Labs: Na 125, K+ 4.2, Creatinine 2, BNP > 2500

ECG from triage is shown… Read more →

Left Ventricular Assist Device

29 May
May 29, 2014

Left Ventricular Assist Device (LVAD)The first left ventricular assist device (LVAD) was performed in 1984 and since that time there is an increasingly growing population of patients with LVADs.  This means ED physicians will be seeing more and more of these patients in the ED and should have a basic understanding of how these devices work and have an adequate understanding of common complications and an approach to evaluate these patients. LVADs are typically used for end-stage heart failure for both a bridge to transplantion and for long-term quality of life improvement. Most of the information for this post comes from a great review article written by Chris Partyka et al in EMA 2014. Read more →

Rivaroxaban for Treatment of Symptomatic Pulmonary Embolism

26 May
May 26, 2014

Pulmonary EmbolismTypically, the treatment of acute pulmonary embolism consists of administration of unfractionated heparin or low molecular weight heparin (i.e. enoxaparin) overlapped with vitamin K antagonists (i.e. warfarin).  This can be a very effective treatment regimen, but also very complex.  New direct Xa inhibitors are being used more and more in clinical practice with prevention of venothromboembolism (EINSTEIN-DVT Trial), after major orthopedic surgery (RECORD1 Trial), prevention of stroke in patents with atrial fibrillation (ROCKET-AF Trial) , and in the treatment of acute coronary syndromes.  Recently, the EINSTEIN-PE Trial evaluated oral rivaroxaban for treatment of symptomatic pulmonary embolism. Read more →

Intravenous Fluids and Alcohol Intoxication

01 May
May 1, 2014

Intravenous Fluids and Alcohol IntoxicationFrequently, patients with acute alcohol intoxication are brought to the emergency department (ED) for evaluation and treatment.  Although practice patterns vary, it is not an uncommon practice to give normal saline to these patients in the hopes that the saline will cause a dilution effect on the level of alcohol helping patients sober faster and therefore having a shorter length of stay in the ED.  At the end of 2013 a study was published evaluating intravenous fluids and alcohol intoxication. Read more →

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