What's in a Blood Gas? VBG vs ABG

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What's in a Blood Gas? VBG vs ABG

You’re deep into a busy shift. Pushing yourself to see more volume towards the end of the year, you find yourself actively managing 8 patients.  You have 2 patients with difficulty breathing you believe have COPD exacerbations and 1 patient with a history of T1DM who has a critical high finger stick blood sugar and ketones in their urine.  You send VBGs as part of the work up for all these patients finding hypercarbia for the patients who have COPD exacerbations and a significant metabolic acidosis in the patient with T1DM confirming your diagnosis of DKA. You are in the process of admitting these patients when you face questions from your colleagues in-house as to why you didn’t perform an ABG on these patients?

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EKG Toxicology

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EKG Toxicology

Emergency medicine physicians frequently assess and treat patients who have accidental or intentional poisonings. United States poison centers receive over two million case referrals per year. And, about 20% of these poisonings present to an Emergency Department for evaluation. Evaluation of these patients always includes a history and physical, but further testing can provide valuable information. Blood work is often be needed, but an EKG is a faster, cheaper tool that can provide key pieces of information prompting early interventions. 

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Back to Basics: Pelvic XRays

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Back to Basics: Pelvic XRays

Pelvic Xrays are a key component of trauma, fractures and dislocations seen every day in the ED, but when is the last time you went back over the anatomy and radiographic tips and tricks of the pelvic radiograph? Join Dr. Mand's thorough break down of this commonly used ED diagnostic - the Pelvic XR.

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Interpretation of Pulmonary Function Tests in the ED

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Interpretation of Pulmonary Function Tests in the ED

While formal pulmonary function testing is not often (if ever) performed in the ED, many patients with a history of COPD, asthma, CHF, sarcoidosis, etc, have had pulmonary function testing performed in the past.  Having an understanding of the underlying pathophysiology of these conditions, physiology of the lungs and respiration, and understanding of how the testing is performed is critical to being able to appropriately interpret the results of these test and apply the test results to our patients.

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Interpretation of Thyroid Studies in the Emergency Department

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Interpretation of Thyroid Studies in the Emergency Department

Thyroid studies, often lying in the depths of any medical student differential, are an important tool in the Emergency Physician's toolkit, and knowing what to order when is a key part of using them wisely. This week, Dr. Makinen gives us a breakdown of thyroid pathology and testing.

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Laboratory Evaluation of Sickle Cell Disease in the ED

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Laboratory Evaluation of Sickle Cell Disease in the ED

Given the morbidity of sickle cell disease, these patients frequently present to the emergency department, raising questions of: what laboratory testing is needed in these patients? And, how do we interpret commonly ordered labs in these patients? This article will discuss the basic principles of these commonly ordered studies in hopes of delineating when they are necessary and how they can help in the evaluation of the sickle cell patient presenting to the emergency department.

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Heart Blocks: A Primer

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Heart Blocks: A Primer

We order and interpret numerous EKG’s during our shifts in the emergency department. EKG interpretation is one of the skills we need to be competent in and comfortable with as an emergency medicine physician. STEMI’s, ischemic changes and arrhythmias are some of the most important findings we focus on, and although straightforward, heart blocks can be easily overlooked. The goal of this post is to go over some of the most common and clinically relevant conduction blocks, how to manage them and what their disposition are.

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Pro's and Con's of Procalcitonin

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Pro's and Con's of Procalcitonin

Procalcitonin was reviewed on Taming the SRU in the context of other biomarkers (ESR, CRP) last year with a grand rounds discussion of its utility in the setting of a febrile 7 week old. As procalcitonin has continued to gain traction in the world of pediatric EM – receiving evaluation as part of proposed protocols for management of febrile infants (1) and for its utility as an aid to diagnosis of Serious Bacterial Infection (2,3) – we turned our attention this year to procalcitonin’s use in adults. Procalcitonin testing has been studied and available for decades (as St. Emlyn’s noted in an update earlier this year), but has not really established itself in widespread use in adults (as EMDocs noted in a sepsis update in 2014). In this blog post, we take the approach of going back to what is known (and is NOT known) about the biochemical basics of this molecule to give context to the sometimes confusing smorgasbord of proposed applications for procalcitonin testing that exists in the literature.

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Soft Tissue Neck Radiographs - Are They Useful?

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Soft Tissue Neck Radiographs - Are They Useful?

In March 2015, Dr. Renne did a Grand Rounds lecture on soft tissue neck radiographs, which offers a great review of normal anatomy and systematic approach to reading films (“CHESS”). Yet, in my small, informal (not scientific at all) poll of some of our residents, none had ever ordered a soft tissue neck film. Are soft tissue neck radiographs useful? You be the judge. 

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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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