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…
A 65-year-old male with history of diabetes mellitus type 2, hypertension, and hypothyroidism presented to the ED with nausea and vomiting that began that morning. He also reported generalized weakness and decreased exercise tolerance. Upon initial presentation, the patient had a heart rate of 109 per minute, blood pressure 107/68 Read more…
February’s Food & Journal Club (FJC) article was chosen by one of the senior residents to open up a discussion regarding evaluation of chest pain in the ED and the utility of the HEART score in our patient population. The gracious Dr. Stetz hosted, the venerable Dr. Wiener presided, and 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…
As you sit down at your workstation to finally catch up on some of those notes you’ve been putting off until the end of your shift, one of the nurses comes to notify you… “You remember that patient in room 4 with the leg pain? This is her urine…” You Read more…