Author Archive for: srrezaie

Five Critical Care Articles For Your Clinical Practice

17 Feb
February 17, 2014

Five Critical Care Articles For Your Clinical PracticeCritical illness is a life-threatening multisystem process that can result in significant morbidity and mortality. Timely, appropriate, and effective care for these patients is something all emergency physicians strive for. Using data from clinical trials of previous years, we can improve patient management and outcomes. In this post, I list my five critical care articles for your clinical practice in the care of these patients. Read more →

ECG Basics

15 Feb
February 15, 2014

ECG BasicsElectrocardiography is a fundamental part of cardiovascular assessment. It is an essential tool for investigating cardiac arrhythmias and ischemia. Just because electrocardiography is a basic skill in EM doesn’t mean that our skills should be basic…we must be the EXPERTS! Below is a summary of some ECG basics including:

  • ECG Measurements
  • ECG Rate
  • ECG Axis

 

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High Sensitivity Troponin Testing

06 Feb
February 6, 2014

High Sensitivity Troponin TestingTroponin testing is an important component of the diagnostic workup and management of acute coronary syndromes (ACS). The increasing sensitivity of troponin assays has lowered the number of potentially missed ACS diagnoses, but this has also created a diagnostic challenge due to a decrease in the specificity of the test. From 1995 to 2007, the limit of troponin detection fell from 0.5 ng/mL to 0.006 ng/mL (see below graph). Robert Jesse summed up this frustration with the following quote:

When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test. Read more →

Relationship of Radiocontrast, Iodine, and Seafood Allergies

04 Feb
February 4, 2014

Relationship of Radiocontrast, Iodine, and Seafood AllergiesComputed Tomography (CT) scan using radiocontrast is one of the most common imaging modalities used in emergency departments today. Several studies and my own anecdotal experiences indicate that both physicians and patients believe that iodine allergies are linked to seafood allergies and that both are related to a disproportionate increased risk of “allergic” reactions to radiocontrast agents. To add further insult to injury, some hospitals have premedication protocols with steroids and antihistamines requiring up to 12 hours before CT scans with intravenous contrast can be performed. So what is the relationship of radiocontrast, iodine, and seafood allergies? Read more →

Is Pelvic Exam in the Emergency Department Useful?

30 Jan
January 30, 2014

Pelvic Exam SpeculumWomen with undifferentiated abdominal pain and/or vaginal bleeding commonly present to the emergency department.  Many textbooks advocate for the pelvic exam as an essential part of the history and physical exam. Performance of this portion of the exam is time consuming to the physician and uncomfortable for the patient. It is with great regularity that emergency medicine physicians make clinical decisions based on information derived from it, but is this information reliable and does it effect the clinical plan of patients? Read more →

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