It’s Sunday at 7 pm. You walk into your ED and there are three patients sitting there looking at you anxiously, with that sick but not quite crashing look on their faces. The first patient is a 15-year-old female. Her vitals are borderline abnormal and she’s staring at you with Read more…
A 40-year-old male with a past medical history of paraplegia presents with four days of right thigh swelling. He initially noticed a small ulcer on his thigh and tried home treatments with alcohol swabs and peroxide rinses. He reports worsening swelling and pain from the area and also notes hematuria, 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…
A 30-year-old right-hand-dominant man presents with complaints of pain and swelling at the distal phalangeal level of his left index finger. The symptoms began 5 hours ago shortly after he was injured while using a paint injection gun. He received a dose of cephalexin, ibuprofen, and tetanus prophylaxis. The radiograph 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…
What everyone should know about dialysis access (things you’ll learn about in this article in bold): How to evaluate a hemodialysis access How to manage a bleeding hemodialysis access How to evaluate and manage a non-functioning/clotted access How to manage an infected access/fever in a dialysis patient Complications of peritoneal Read more…
In last week’s post, we reviewed Pluymaekers et al (1), a randomized control trial from the Netherlands on early or delayed cardioversion for recent-onset atrial fibrillation (AF). In this post, we will analyze our practice in the U.S. and discuss some of the arguments for and against cardioversion in the Read more…
Kudos to Dr. Beth Hanson. One of our recently graduated fourth-year residents, who will be an attending in Colorado, went above and beyond the call of duty just a few weeks ago. Dr. Aleksandr Gleyzer nominated Dr. Hanson for acknowledgment. It was a relatively busy CCT shift when Dr. Hanson Read more…
A recent NEJM article, “Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation” by Pluymaekers et al has reinvigorated debate in the blogosphere, academia conference halls, and podcast-dom over management of recent-onset atrial fibrillation (AF) (1,2,3). Prior studies have demonstrated that cardioversion for recent-onset atrial fibrillation (typically defined by a duration Read more…