Author Archive for: srrezaie

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 →

Chest Pain: Can we do 2-hour rule outs?

26 Jan
January 26, 2014

Chest Pain and TimeHospital admissions for chest pain often incur costly and resource-intensive workups for ACS. Is there a way to identify a low risk group who can be discharged home in a timely manner, without further workup, and without short-term adverse events from ACS? Read more →

Chest Pain: Coronary CT Angiography in the ED

26 Jan
January 26, 2014

chest pain and CCTAIt is well known that taking a good history and physical, getting a non-ischemic EKG, and serial cardiac biomarkers, results in a risk of death/AMI of <5% in 30 days. Patients, in whom you still suspect have CAD, should undergo provocative testing within the next 72 hours based on the AHA/ACC guidelines. Their guidelines deem provocative testing as including:

  • Exercise treadmill stress test,
  • Myocardial perfusion scan,
  • Stress echocardiography, and/or
  • Coronary CT angiography (CCTA).   Read more →

Three Predictors of Success in Cardiac Arrest

25 Jan
January 25, 2014

DefibrillationThe goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes.  Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with good patient outcomes. Read more →

The HEART Score: A New ED Chest Pain Risk Stratification Score

10 Jan
January 10, 2014

Chest PainChest pain is a common presentation complaint to the emergency department (ED) and has a wide range of etiologies including urgent diagnoses (i.e. acute coronary syndrome (ACS), pulmonary embolism, aortic dissection) and non-urgent diagnoses (i.e. musculoskeletal pain, gastroesophageal reflux disease (GERD), pericarditis). The challenge in the ED is to not only to identify high risk patients but also to identify patients who can be safely discharged home. Specifically, when dealing with ACS, dynamic ECG changes or positive cardiac biomarkers is pretty much a slam dunk admission in most cases, but a lack of these does not completely rule out ACS. Currently, most guidelines and risk stratification scores focus on the identification of high risk ACS patients that would benefit from early aggressive therapies, but what about all the other chest pain patients that don’t have ACS… are they accounted for? Read more →

Optimization WordPress Plugins & Solutions by W3 EDGE