Author Archive for: srrezaie

Age Adjusted D-Dimer Testing

28 Apr
April 28, 2014

ThromboembolismD-dimer testing is sensitive for thrombus formation, and in patients who are not high risk, this test is used to rule-out venous thromboembolism. D-dimer has been shown to increase with age, which can cause a lower specificity (i.e. more false positive tests) in older patients.  Specificity can range from 49 – 67% in patients ≤ 50 years of age, but in older patients (i.e. ≥ 80 years of age) the specificity is quoted as 0 – 18%. The result of this is, older patients often have more diagnostic imaging, but a higher cut-off may lead to increased false negative cases (i.e. missed VTE) and make this strategy less safe. So could age adjusted d-dimer testing increase specificity without affecting sensitivity?

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Topical Anesthetic Use on Corneal Abrasions

21 Apr
April 21, 2014

Corneal AbrasionPatients with corneal abrasions typically come to the emergency department for eye pain.  Most physicians treat these with topical antibiotics, oral analgesia, and for those who are lucky enough 48 – 72 hour follow up with ophthalmology. Oral analgesia does a poor job of controlling these patients pain. Tetracaine is an esterase type anesthetic with a onset of action of 10 – 20 seconds and a duration of action of 10 – 15 minutes.  Use of topical anesthetics are very effective at reducing pain, but there use is discouraged secondary to poor wound healing of the corneal epithelium.  So what is the evidence for topical anesthetic use on corneal abrasions? Read more →

ECG Changes of Hyperkalemia

17 Apr
April 17, 2014

Heart and ECGHyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. It is important to remember that the electrophysiologic effects of hyperkalemia are directly proportional to both the absolute plasma potassium and its rate of rise. However, neither the ECG nor the plasma potassium alone are an adequate index of the severity of hyperkalemia, and therefore providers should have a low threshold to initiate therapy. Classic teaching of the chronological ECG changes of hyperkalemia include:

  1. Peaked T waves
  2. Prolongation of PR interval
  3. Widening QRS Complex
  4. Loss of P wave
  5. “Sine Wave”
  6. Asystole

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From Hippocrates to Osler to FOAM

04 Apr
April 4, 2014

FOAM LogoAs many know Free Open Access Med(ical Ed)ucation (FOAM) is a concept that was developed in June 2012 at a pub in Ireland. Since its creation FOAM has developed into a collection of constantly evolving, collaborative, and interactive resources and tools with one main objective…to make the world a better place. At the heart of FOAM is the philosophy that high-quality medical education should be free and accessible to all who care for patients and to those who teach the art and science of medicine. Recently, I watched a video from the 2013 Social Media And Critical Care (SMACC) Conference given by Joe Lex that made me realize although the acronym only came into being recently, maybe the concept had historical origins (From Hippocrates to Osler to FOAM).

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Preoxygenation and Apneic Oxygenation

24 Mar
March 24, 2014

Safe ApneaPreoxygenation and apneic oxygenation are key in emergency airway management, prevention of desaturation, and very important to patient safety.  One of the best papers I have ever read on this was written by Scott D. Weingart (@emcrit) and Richard M. Levitan (@airwaycam) in the Annals of Emergency Medicine in March 2012. This article reviewed techniques in preoxygenation and peri-intubation oxygenation in adult patients requiring tracheal intubation.  Read more →

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