Archive for category: Clinical

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

10 Jan
January 10, 2014

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketChest 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 […]

Modified Sgarbossa Criteria: Ready for Primetime?

03 Dec
December 3, 2013

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketThe recognition of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult and frustrating to both emergency medicine physicians and cardiologists.  According to the 2004 STEMI guidelines, emergent reperfusion therapy was recommended to patients with suspected ischemia and new LBBB however, the new […]

Does a Porcelain Gallbladder Equal Gallbladder Cancer?

21 Nov
November 21, 2013

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketGallbladder cancer (GBC) incidence ranges from 12 – 62% when porcelain gallbladder (PGB) is seen.  You ever wonder where these numbers come from?  Well, these are the quoted numbers from two studies done in 1959 and 1966.  These studies also indicated that if porcelain gallbladder was seen, that a […]

Should we stop prescribing Azithromycin in the ED?

19 Nov
November 19, 2013

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketIn 2011, Azithromycin was the 7th most prescribed (55.3 million prescriptions) medication according to IMS Health.  There have been several publications indicating that the use of macrolide antibiotics, increase risk of serious ventricular arrhythmias and sudden cardiac death (FDA Adverse Event Reporting System). Specifically, 2 recent studies in the […]

CPR: Hands-on or Hands-off Defibrillation

01 Nov
November 1, 2013

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketPauses in chest compressions are known to be detrimental to survival in cardiac arrest, so much so that the 2010 American Heart Association (AHA) emphasize high-quality compressions while minimizing interruptions. There have been some studies that now advocate for continuous chest compressions during a defibrillation shock. There have been […]

Is ATLS wrong about palpable blood pressure estimates?

01 Nov
November 1, 2013

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketIn Advanced Trauma Life Support (ATLS), we learned that a carotid, femoral, and radial pulse correlates to a certain systolic blood pressure (SBP) in hypotensive trauma patients.  Specifically ATLS stated:  Carotid pulse only = SBP 60 – 70 mmHg  Carotid & Femoral pulse only = SBP 70 – 80 […]

NG Lavage: Indicated or Outdated?

01 Nov
November 1, 2013

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketNasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence support the logic? Most studies state that endoscopy should occur within 24 hours of presentation, but the optimal timing within the first 24 hours is unclear. […]

Chest Pain: What is the Value of a Good History?

01 Nov
November 1, 2013

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketEvery year there are 6 million visits to the Emergency Department (ED) for chest pain, and approximately 2 million hospital admissions each year.  This is approximately about 10% of ED visits and 25% of hospital admissions with 85% of these admissions receiving a diagnosis of a non-ischemic etiology to […]

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