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SCOT-HEART: CCTA Decreases Long-Term Risk of MI and Death?

Background: CT coronary angiography (CTCA) is a relatively new technology that has gained popularity over the past few years in evaluating patients presenting with chest pain. CTCA is an anatomic test that has been shown to increase downstream testing and increase healthcare ...

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Cardiovascular

Clinical Pearls from ACEP 2018 – San Diego, CA

This year ACEP 2018 took place in San Diego, CA from Oct 1st– 4th, 2018.  There were lots of amazing speakers and topics as was evidenced by the eruption of everyone’s twitter feeds with the #ACEP18 hashtag.  I was fortunate ...

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Approach to the Critically Ill Child: Shock

If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, “kids are not just small adults”, and so I won’t say it again. Well, I guess I just did, ...

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Pediatrics

Coronary Computed Tomography Angiography (CCTA): The Holy Grail of "Low Risk" Chest Pain Evaluation?

Background: CCTA has become a popular modality in the ED setting to assess anatomic atherosclerotic disease in patients presenting with chest pain.  Advocates of CCTA feel that CCTA has a greater accuracy in identifying obstructive coronary artery disease and identification of ...

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Cardiovascular

Coronary Computed Tomography Angiography (CCTA): The Holy Grail of “Low Risk” Chest Pain Evaluation?

Background: CCTA has become a popular modality in the ED setting to assess anatomic atherosclerotic disease in patients presenting with chest pain.  Advocates of CCTA feel that CCTA has a greater accuracy in identifying obstructive coronary artery disease and identification of ...

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Cardiovascular

Accidental Hypothermia

Definition: Accidental hypothermia is an unintentional core body temperature of < 35°C when heat loss to surroundings is greater than heat generation Most frequent cause is environmental exposure Patient with impaired thermoregulation can develop hypothermia in relatively warm environments Elderly, ...

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Environmental

LOMAGHI Trial: Magnesium Sulfate for Rapid Atrial Fibrillation?

Background: Currently, several medications are recommended for the management of atrial fibrillation with rapid ventricular response in the emergency department including calcium channel blockers, beta blockers and digoxin (the optimal choice is still up for debate). Magnesium sulfate may play a role ...

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Cardiovascular

Building the “Perfect” Curriculum

I was asked to give a talk at ACEP 2018 on Building the Perfect Curriculum and given 25 minutes to make this happen.  As you can imagine there is no way the entirety of building a perfect curriculum can be ...

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Can’t We All Just Get Along? A Generational Survival Guide

Background: For the 1st time we have 4 generations in the workplace.  The reasons for this include, people are living longer on one end of the scale and there has been a huge acceleration in speed of information leading to quicker development ...

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The CASA Exam: A Follow Up Study

Background: POCUS has become a powerful tool in the evaluation of critically ill patients in the ED.  However, in patients with cardiac arrest, the use of POCUS has been shown to significantly increase the duration of pauses.  This is concerning as ...

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Resuscitation
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