Platelet transfusion is a hotly debated topic and practice pattern variation is high, which is a great time to get back to the basics. Dr. Urbanowicz gets back to the basics of platelet function assays and the conflicted role of transfusion if they are deemed dysfunctional
Read MoreIs the patient in front of you with chest pain and a left bundle branch block an MI? Often the clinical presentation will dictate level of concern, but what about equivocal cases? Join Dr. Walsh as he reviews the diagnostic criteria for MI including Sgarbossa, modified Sgarbossa and a unifying algorithm.
Read MorePulmonary embolism (PE) is one of the big “can’t miss” diagnoses in the emergency department. Unfortunately, presenting symptoms are often vague, and definitive diagnostic testing is expensive and comes with risks of radiation and contrast to the patient. In order to avoid missing a PE while mitigating the risks associated with overtesting, some clinical decision tools have been created to aid in the diagnostic process. We will focus on two of these commonly used decision tools: the PERC rule and the WELLS score for PE.
Read MoreClearance of cervical spine is more within the house of Emergency Medicine than anywhere else, so it implores that when we clear a cervical spine using our rules, we take a second to consider the sensitivity, specificity and even more importantly the exclusions that were used in the derivation and validations in these studies. Dr. Gawron takes a look through these rules for our review
Read MoreThromboelastography (TEG) may be less ordered than traditional coagulation studies, however gives much more specific and detailed information to your patient’s coagulopathy. Join Dr. Wolochatiuk as she explores the indications and interpretations of the TEG.
Read MoreEver have a patient that looks more concerning than their EKG? Perhaps their ischemia is in that anatomically difficult to access right ventricle or even posterior. Join Dr. Connelly in looking at the utility of right sided, posterior and Lewis leads and bring something new to your next chest pain patient.
Read MoreIt’s been called “the refuge of the intellectually destitute (physician)” by Amal Muttu. The CBC is a much maligned test that is nevertheless one of the the most frequently ordered diagnostic tests in the ED. To truly know how to interpret this test, one must understand its individual components, the possible causes of variations from normal for those components, and how it integrates into the clinical presentation of the patient. Also, it can’t help but to know and understand some of the historical background…
Read MoreIt is early on in your residency training, when you receive sign-out of a patient who was involved in an MVC with multiple injuries including a stable pelvic injury. The patient, a middle-aged male, has not voided three hours into his visit and there is no mention of any obvious genital trauma. He has had a negative FAST exam in addition to the rest of your primary and secondary assessment. The patient mentions to the nurse that he is trying to urinate but cannot void and has some discomfort. The bladder scan shows that the patient has about 500cc of urine and when the nurse goes to place a urinary catheter she pauses as she sees what appears to be dried blood at the urethral opening. After reassessing the patient who is still hemodynamically stable with normal mentation, his findings are discussed with Urology who recommend getting a retrograde urethrogram prior to any additional procedures.
Read MoreMassive Transfusion (MT) is a life-saving trigger in trauma centers, but heavy is the burden of activating significant resources without knowing the blood products will go to good use. The ABC is the ACS recommendation, is easy and requires no additional testing, however newer weighted scores like PWH and TASH have showed promise in external validations. This week, Dr. Laurence takes a deep dive into the literature behind these triggers, their validation as well as some take aways for your use of life-saving Massive Transfusion.
Read MoreWhen a child comes in to the emergency department for head trauma, it can be difficult to balance unwanted, and possibly unnecessary radiation, with the risk of missing clinically significant head trauma. CT scans of the head allow providers to rapidly identify, and subsequently address dangerous and potentially life-threatening intracranial trauma and hemorrhages. However, as with everything in medicine, a CT scan is not without risks, particularly in the pediatric patient. With over 500,000 ED visits per year dedicated to pediatric head traumas, this is a challenge that emergency medicine providers face frequently (1). A study published in 2001 suggests that approximately 170 deaths were attributable to one year of CT head examinations in pediatric patients (2), and utilization of CT imaging has only increased since. Therefore, as with any radiation based imaging, careful consideration should be given to whether the test is truly necessary. As mechanism of injury and post-trauma symptoms can range drastically, it can be difficult to accurately assess the appropriateness of imaging in a child. As such, the pediatric emergency care applied research network (PECARN) worked to develop a clinical decision tool to guide clinicians in the need for head CT following pediatric head trauma.
Read MoreChest pain is a part of our everyday practice, as has become utilization of the HEART score. Successfully weathering a storm of validation, it is incumbent upon us to know the data and variability to its use in the ED. This week Dr. Hunt will take us through the diagnostic view on the HEART score and the data behind it.
Read MoreThe sore hip in the pediatric patient is a complaint that is important to approach with caution as the repercussions of missing the diagnosis of septic arthritis can be life threatening.
Read MoreIn this post, we discuss necrotizing fasciitis and whether the LRINEC score is a useful decision-aid for the emergency physician when this disease is suspected.
Read MoreYou’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?
Read MoreIs the KUB a relic of an era of simpler diagnostics or a viable alternative to the cost and radiation of cross-sectional imaging? Join Dr. Skrobut as he parces through the indications, pathologies and literature of the abdominal plain film.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
