Small Kids and Squiggle Lines - An Introduction to Pediatric EKG Interpretation

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Small Kids and Squiggle Lines - An Introduction to Pediatric EKG Interpretation

It’s a typical shift in your community shop when you see a patient on the board that makes you nervous. 2 year old male with syncope. It’s been awhile since you have treated someone born in the 21st century and you know this child’s workup will likely involve an EKG. The closest pediatric hospital is 2 hours away.  How comfortable do you feel interpreting the squiggle lines generated by this little heart?

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Liver Function Tests Decoded

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Liver Function Tests Decoded

If the chief complaint of your patient is abdominal pain, altered mental status, overdose, generalized weakness chances are you at least considered ordering a hepatic panel. In fact, studies show that the hepatic panel is the third most common laboratory test ordered in the emergency department only behind the CBC and renal panel. If emergency medicine physicians are so quick to order this test, it is important to also know how to interpret all the little red arrows that often accompany your results. For this we will review each component and even (wait for it) … a little biochemistry!

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What's in a Tap: CSF Analysis

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What's in a Tap: CSF Analysis

Lumbar punctures are common procedures to the Emergency Medical provider.  Obtaining the fluid is just part of the battle however with this procedure.  With the flood of results often comes a fair bit of confusion as to how to interpret them.  After reading this post, you'll be able to:

  • Use cell counts, protein, and glucose to distinguish between various etiologies of meningitis and determine when to order further testing
  • Understand markers of bleeding in CSF and methods of distinguishing SAH from traumatic tap

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Back to the Basics: Demystifying the UA

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Back to the Basics: Demystifying the UA

Amongst the various diagnostic studies that can be obtained in the ED, urinalysis is a virtually ubiquitous test. Urine itself reflects the functioning of the human body in both health and disease and the values it comprises can give us information regarding a myriad of conditions from infections, metabolic or endocrine derangements, and toxidromes to neoplastic processes and pregnancy. Despite this, many of the elements of even the standard urinalysis are often overlooked and underappreciated. In this talk we will explore some of these values and hopefully gain a renewed respect for the “golden cup of answers” and all that it may reveal.

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Cardiac Biomarkers

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Cardiac Biomarkers

Real time, high sensitivity serum biomarkers have played an enormous part in the timely identification and intervention on of cardiac pathology in the Emergency Department. These biomarkers have sufficient sensitivity to identify cardiomyocyte injury even in the absence of physical exam, radiographic, or electrocardiographic findings. Unfortunately, the utility of these studies may be limited or obfuscated in certain clinical contexts. This article will discuss the possible pitfalls and obstacles physicians may encounter in interpreting cardiac biomarkers

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EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis

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EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis

Paracentesis and thoracentesis are relatively common procedures in the Emergency Department but the analysis of the fluid can always but a touch confusing.  In this post, PGY-1 Dr. Michael Klaszky walks us through the analysis of pleural fluid and ascitic fluid.

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Hepatitis Panel Interpretation

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Viral hepatitis is a commonly encountered and increasing problem thanks in part to the rise in injection drug use. Here I review the screening recommendations and interpretation of hepatitis B and C serology.  Screening recommendations are based on CDC and US Preventative Task Force guidelines. Prevalence of viral hepatitis is much higher in the ED setting and may warrant expanded screening. This is an active area of research and there are as of yet no formal professional recommendations regarding expanded screening.  In this post we will explore the current screening recommendations for HBV and HCV and detail the interpretation of the test findings.

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ESR, CRP, & Procalcitonin: Acute Inflammatory Markers in the ED

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ESR, CRP, & Procalcitonin: Acute Inflammatory Markers in the ED

Working in the ED one day you seem to hit a run of patients in whom consultants have asked you to order an ESR, CRP.  First, podiatry asked for them for a patient with 1st metatarsal osteomyelitis.  Spine surgery wanted the same for a patient with diskitis. And, ortho wanted them for a possible septic.  You think to yourself, “what am I or my consultant going to do with these test results?” “What are these inflammatory markers anyhow?” And, “what patient’s should I be ordering them in.”

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Clinical Approach to Knee Radiographs

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Early in the morning, you begin your day in your local emergency department. After getting yourself situated, a slow trickle of patients begin to appear on the board. It appears to be a normal morning, all except for the fact that five patients appear, one after the other, who have the same chief complaint: “Knee pain”. It is a good thing you brushed up on reading knee x-rays recently!

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Clinical Concepts in CT Imaging of the Chest

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Clinical Concepts in CT Imaging of the Chest

A 45 yo Female presents to the ED with sudden onset of chest pain, described as worse when taking a deep breath.  She is significantly short of breath and appears distressed.  She recently underwent a total right knee arthroplasty and reports having been bedridden secondary to pain.  Physical exam is remarkable for a right lower extremity with surgical incisions that clean, dry, intact; however, her left lower extremity is swollen with significant tenderness along the popliteal fossa and calf.  

Vitals: Temp 99.2HR 120RR: 28 BP:  130/80 SpO2 90% on RA.

A CTPA is ordered...

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