Benign Early Repolarization Benign Early Repolarization is the most common, “normal” ECG variant Occurs in about 1% of the population Degree of J point elevation is usually highest in the mid-left precordial leads (V2-V5) and never seen in aVR Isolated benign early repolarization in limb leads is very rare (inferior Read more…
Last month Academic Emergency Medicine published the article “Can emergency physician gestalt ‘rule in’ or ‘rule out’ acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study”. The following is a critique by Dr. deSouza and Dr. Sinert: In this large multi-center, prospective diagnostic accuracy study, the investigators conclude Read more…
From the last two posts (Part 1 and Part 2) we know that observing patients for chest pain to “rule out ACS” may no longer be relevant now that we have new diagnostic modalities and updated evidence. The tests we do in the observation unit are unlikely to help us Read more…
This month’s Save of the Month goes to Dr. Eric (Every)Rose(Has Its Thorn)Man. The Case A 53-year-old male with no reported past medical history presented with “sudden left side chest pain” x 15 mins. Vitals in triage were as follows: HR 125/min BP 163/113 mm Hg RR 20/min SpO2 Read more…
Last week’s post described the history of observation units, and how technology and knowledge has advanced since the early days of observation. Now, we are identifying more MIs in the ED and safely discharging a large swath of low-risk chest pain patients. So, who is left for observation? Are there Read more…
Accurate and expeditious diagnosis of acute myocardial infarction or acute coronary syndrome (ACS) is one of the key charges of emergency medicine providers. Chest pain is the second most common reason for emergency department visits in the United States and coronary artery disease is our leading cause of death (1,2). Read more…
Here are some highlights from our weekly education conference from May 1, 2019. Dr. Andy Wong gave his senior lecture on “Things That Sting You”: Fire Ants sting you They are found in the Southeast US Local care for stings is all that’s needed – use ice for pain and Read more…
Diabetic ketoacidosis (DKA) is seen so often in our ED we may take the diagnosis and treatment for granted. Just follow the numbers – potassium 3.5, glucose 250, insulin drip at 0.1 U/kg/hr. But it helps to understand the underlying pathophysiology, because this can help you form a more nuanced Read more…
They say Emergency Medicine has one of the highest rates of burnout among any medical specialty. This is likely due to demanding nature of our work in the ED, as well as our erratic shift hours. However, working endless shifts in a busy ED isn’t the only option for emergency Read more…
A 54-year-old male with history of alcohol abuse presents with right forearm pain and swelling following a fall two days ago. The pain is constant, sharp, “radio buzzing”, and 10/10. He also reports redness, swelling, and “feels cold”. He denies fevers, LOC, CP, SOB, weakness/numbness. Initial VS: HR 120/min, RR 20/min, Read more…