If you have ever nodded along as someone described an MRI series weighting, you are not alone. As this modality becomes more accessible to the Emergency Physician, it is incumbent on us to familiarize ourselves with the critical aspects and critical diagnoses of MRI and how to speak the language. Dr. Zalesky takes us on a tour of the physics, indications and low-down of MRI from the ED.
Read MoreThe 2013 ACC/AHA STEMI guidelines outline, with specific age and gender-related cutoffs for ST segment elevation in certain leads. While these are clinically important, there are several STEMI equivalents or EKG patterns that do not meet these criteria but should point the practitioner to consult with an interventional cardiologist. These STEMI equivalents are found in 10-25% of cases of coronary occlusion, making it imperative that emergency personnel be familiar with these patterns.
Read MoreUltrasound continues to push into more and more of the physical exam, and nowhere is that clearer than in the musculoskeletal exam. From diagnosing and prognosticating patellar tendon ruptures and ligamentous injuries to being a procedural adjunct in shoulder dislocation to critical identification of necrotizing fasciitis, it continues to push boundaries. Dr. Broadstock gives us a look at some of the applications you need to make yourself a better practitioner in this week’s Diagnostics of Musculoskeletal US post.
Read MoreUpper extremity trauma and pain related complaints are frequently encountered in the Emergency Department. In this post, we cover the basics of the anatomy of the shoulder and elbow joint, the radiographic studies frequently performed in the evaluation of shoulder/elbow injuries, and cover some commonly encountered injuries of these joints.
Read MoreHip and knee pain almost categorically get an X-Ray in the ED, but when do you need more? And when could another view help you avoid a more costly imaging test? This week join Dr. Gressick as she gets back to the basics in the acquisition and interpretation of the hip and knee X-Rays
Read MoreSyncope is a common presenting complaint to the emergency department. Estimates suggest that 1- 3 percent of ED visits are for syncope.(1) While the large majority of these episodes are often benign, they can suggest underlying life-threatening etiologies such as arrhythmias, pulmonary embolism, and stroke. The disposition of these patients can represent a difficult quandary at times. In fact, emergency physicians are only able to establish a clear underlying diagnosis in approximately 50% of syncope patients after obtaining an HPI, physical exam and ECG. (2)
Should these patients be observed in the ED? And, if so, for how long? Should they be admitted to the hospital for further workup and observation? Should they instead be discharged home with close follow-up?
Read MoreStrep pharyngitis, commonly known as “strep throat” is a bacterial infection of the oropharynx caused by group A beta hemolytic streptococci (GAS), specifically S. pyogenes. This infection affects more than 500,000,000 people annually worldwide per year, ultimately resulting in a significant number of doctor’s visits, including to the ED (1). The classic clinical presentation of GAS pharyngitis includes sudden onset of sore throat, fever, and odynophagia. If untreated, complications of GAS pharyngitis include scarlet fever, rheumatic heart disease, post-streptococcal glomerulonephritis and peri-tonsillar abscess. In this post, we explore the diagnostic evaluation of pharyngitis with special attention to the use of the Centor criteria and rapid antigen testing.
Read MoreDizziness is common and is commonly a frustrating diagnostic dilemma in the ED. As patient’s stories vary between providers, it would be nice if we had a tool that was objective, reproducible and definitive. Enter - the HINTS exam. Join Dr. Ijaz as he discusses this nuanced exam that can change dizziness into a definitive diagnosis.
Read MoreAnion Gap in you obtunded ingestion patient? Weekend gone dry and friends digging through the back of the cabinet? Join Dr. Kimmel as she discusses the diagnostics and therapeutics in toxic alcohol injections and when in doubt, bookmark this for a quick review of their toxicities and metabolites.
Read MorePlatelet 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 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.
