Recurrent Low Risk Chest Pain: GRACE Guidelines

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Recurrent Low Risk Chest Pain: GRACE Guidelines

When providers are early in their training, this tends to lead to questions of “how long is a negative stress test good for?” “What about a negative cath? - Is that good for 2 years, 4, years, 6?” “What about a negative CCTA?”

In the first (of many to come) GRACE guidelines (Guidelines for Reasonable and Appropriate Care in the Emergency Department), SAEM sought to tackle many of these questions as they looked at Recurrent, Low-risk Chest Pain in the Emergency Department.

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Grand Rounds Recap 10.28.20

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Grand Rounds Recap 10.28.20

Check out this week’s Grand Rounds Recap! Dive into colitis on CT via M&M with Dr. Koehler. Understand and treat cardiogenic shock with Drs. Kimmel and Broadstock. Share some laughs and learn about eyes with Visiting Professor Dr. Glaucomflecken. Disposition abnormal cardiac rhythms as seen in the community with Dr. LaFollette

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A Fix for a Stinging Heart - Pericarditis Treatment in the ED

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A Fix for a Stinging Heart - Pericarditis Treatment in the ED

Pericarditis is inflammation of the pericardial sac. Classically, pericarditis presents with sharp and pleuritic chest pain which is relieved by sitting up and forward. Pericarditis has multiple etiologies, but is most commonly idiopathic, assumed to be viral, in developed countries (1). Treatment of pericarditis should be targeted to the underlying etiology if possible (1). For presumed viral, idiopathic causes, most patients are treated with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine (1).

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STEMIs in Disguise

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STEMIs in Disguise

The 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. 

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Diagnostics: Alternative EKG Leads

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Diagnostics: Alternative EKG Leads

Ever 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.

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Grand Rounds Recap 1.9.19

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Grand Rounds Recap 1.9.19

We are excited to share our latest installment of the Grand Rounds Recap with you! Dr. Stettler opened the day with a discussion on leadership styles and how they affect our practice in the emergency department. Next up was Dr. Sabedra with a riveting case of new onset heart failure and acute ischemic stroke in a patient in his twenties. Dr. Berger then gave us a shot to the gut, in a good way, with a lecture on colitis. We then delved into the world of pediatrics with a lecture by Dr. Gray who helps us standardize our approach to evaluating for the possibility of child abuse. Dr. Hughes and Dr. Gottula then ended the day with a practice changing summary of the current literature and a new pathway for the management of NSTEMI.

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Grand Rounds Recap 12.5.2018

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Grand Rounds Recap 12.5.2018

We had another excellent Grand Rounds this week! Dr. Carleton started us off with some thrilling airway cases in his continuing Airway Grand Rounds series. Next, we were transported to Africa for a case based discussion on Global Health with Drs Owens, Sabedra, Ventura, and Murphy-Crews. Dr. Skrobut and Chris Shaw then took us through a deep dive of the current literature on the management of upper GI bleeds. Dr. Ham then taught us about ACE-I induced angioedema through the lens of an amazing case of a patient who required a cricothyrotomy to save her life! Next up, we had Dr. Gleimer go up against Dr. Faryar in our Clincal Pathological Case series where we a classic presentation of Addison’s disease in a pediatric patient. Dr. Hunt then led us through small group discussions on the application of the HEART Score in patients presenting to the ED with chest pain. We wrapped up the day with Dr. Isaac Shaw who presented a the management of SVT in a complicated patient.

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