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?

January 30, 2014

Women 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?

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).  

January 25, 2014

The 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.