Case: You are the senior resident working an afternoon trauma/critical care shift when a rapid response is called in the hospital. Shortly thereafter, an elderly woman with a history of metastatic colon cancer is brought to you by the nursing staff after losing consciousness while undergoing radiation therapy. Triage vitals Read more…
The first save of the month (and decade) goes to consecutive CCT Teams! Team #1: Dr S Johnson and Dr S Gopaul for stabilizing a sick patient and avoiding potentially catastrophic interventions in an undifferentiated patient who could have crashed Team #2: Dr S Desai and Dr R Walsh for Read more…
What is the prevalence of PE in patients who present to the ED with syncope? (This is part 2 of a two-part series.) In our last post, we discussed four studies that attempted to describe the prevalence of pulmonary embolism in ED patients who have experienced syncope. In this post, Read more…
What is the prevalence of PE in patients who present to the ED with syncope? References 1. Prandoni P, Lensing AWA, Prins MH, et al. Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. N Engl J Med [Internet]2016;375(16):1524–31. Available from: https://doi.org/10.1056/NEJMoa1602172 2. Oqab Z, Ganshorn H, Sheldon R. Prevalence Read more…
In a previous post, I presented a case of Takotsubo non-ischemic cardiomyopathy that met “STEMI” criteria and was diagnosed by angiography. Let’s take a moment to discuss some other non-ischemic cause of ST elevation, otherwise known as “STEMI mimics.” 1) Benign Early Repolarization and Left Ventricular Hypertrophy ST-elevation does Read more…
Editorial preface: I will be occasionally using the term occlusion myocardial infarction (OMI) to signify acute coronary occlusions which should be emergently reperfused (thrombolysis or percutaneous coronary intervention). Unfortunately, as OMI inherently does not have ‘false negatives’, I will still begrudgingly include the phrases ACS and STEMI as many are Read more…
A 50-year-old woman with no significant past medical history is brought to the ED via EMS as a “STEMI notification”. As per family, the patient was at the post office when she developed sudden onset chest pain and then syncopized. The patient had not seen a doctor recently and does 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…
Original post available here Answer: This patient is suffering from a posteroinferior MI. The best way to approach ECGs is, like anything else in medicine, systematically. Breaking down each component (rate, rhythm, axis, interval, morphology), we see the following findings on the ECG: Rate: 90/min Rhythm: irregularly irregular, no discernible Read more…
The Case Your notification phone rings, telling you the disaster response team is bringing in an unconscious 25-year-old male. They provide no other information. When he arrives, you get a full story. It turns out that earlier this morning, in a small town nearby, there was no radio response to Read more…