A deep dive analysis of current topics in Emergency Medicine
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…
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…
This article will not attempt to wade into the pathophysiology of acid-base disorders. From reading the nephrology literature, it seems that this topic is more closely akin to theoretical physics than the sturdy biochemistry I learned in college. Researchers can’t even agree on how to define acidosis, much less what Read more…
It’s 15 minutes from change of shift, and you are recovering from a busy overnight in the critical care area of the ED. Suddenly, an intubated patient rolls in the door without prior notification, and EMS is performing chest compressions. “Intubated… three rounds of epinephrine and one round of bicarb Read more…
Scenario: You are evaluating a 58-year-old male with hypertension and cirrhosis who presents with a sharp, right-sided, severe, non-radiating, constant headache that started suddenly two hours ago while he was walking to get something to eat. Shortly after the headache started, he noticed his vision became blurry and Read more…
It is 6 AM and your shift is winding down. The last patient you are about to see is a 20-year-old man with a complaint of tooth pain. On your walk to his room you start to daydream about enjoying a little sunlight after working 6 nights in a row when you notice your patient is carrying an industrial sized bottle of acetaminophen from which he you just saw him pop five pills.
Setting the Scene Your patient is a 21 year-old female with a history of type 1 diabetes mellitus who was brought to the ED by her boyfriend for diminished responsiveness. In a stupor, she is unable to give any history. Her vitals are: BP 102/66, pulse 120, respiratory rate 24, Read more…
You’re sitting in the critical area when EMS bursts through the trauma bay doors with a 34 year-old male with PMH of asthma in respiratory distress. EMS alerts you that they’ve placed a line, started 1g of magnesium sulfate, given 10 mg of dexamethasone, and the patient is on his Read more…
A few months back, I wrote about the lack of accuracy in using peripheral venous blood gas to estimate the CO2 of an arterial sample, particularly when the levels are very high1. My continued review of the subject supports the unreliability of such interpretation of peripheral venous values alone. Dr. Rees, a researcher who Read more…