March 3, 2014

Recently, I have been asked if there are any studies that have been performed over the past few years that should shape the way emergency medicine physicians should practice and can greatly improve patient care. So I asked some of my friends and colleagues if there are any studies that stick out in their minds. Below is a list of four game changers in emergency medicine that others felt were of importance.

February 17, 2014

Critical 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.

February 15, 2014

Electrocardiography 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

February 6, 2014

Troponin 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.

February 4, 2014

Computed 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?
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