To the Cath Lab or Not? You Make the Call! - Part 2

To the Cath Lab or Not?  You Make the Call! - Part 2

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Here is part two of our two part series (click here for part one).  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

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To the Cath Lab or Not? You Make the Call! - Part 1

To the Cath Lab or Not?  You Make the Call! - Part 1

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

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Resus of the Hypotensive Patient Part 2 - Why You Should be Using Peripheral Pressors (and not feeling guilty about it)

Resus of the Hypotensive Patient Part 2 - Why You Should be Using Peripheral Pressors (and not feeling guilty about it)

For the patients we see that are potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discussed how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.  So how do we avoid the harms of excessive IV fluids?  Plan to start peripheral pressors.  

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Resus of the hypotensive patient Part 1 - When IV Fluids Kill

Resus of the hypotensive patient Part 1 - When IV Fluids Kill

There is probably no other drug emergency providers administer more often than IV fluids.  We give them to patients with mild heat exhaustion, gastroenteritis and orthostatic dizziness to name a few.  These patients tend to feel better, go home and no harm comes to them.  However, for the subset of patients with shock and potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discussed how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.    

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What the Heck is Going on with this Pacemaker?!

What the Heck is Going on with this Pacemaker?!

Pacemakers and implantable cardioverter/defibrillators (ICDs) are fascinating little machines.  They were first placed in survivors of sudden cardiac death in 1980, and over the past several decades have become more complex with increasing abilities to sense, pace and defibrillate.  As the population ages and the prevalence of cardiovascular disease increases, patients with pacemakers and ICDs will present more commonly to the emergency department.  It is imperative that the emergency provider have a framework for troubleshooting these devices.  This post will briefly review the use of the "donut" with an implantable pacemaker, as well as three pacemaker malfunctions the emergency provider may encounter.

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Feature Film - Myths and Misconceptions about Testicular Torsion

Feature Film - Myths and Misconceptions about Testicular Torsion

Testicular torsion is present in approximately 3 – 17% of children brought to the ED with scrotal pain.  It has a bimodal incidence in the first year of life and at puberty, when the rapid increase in testicular volume predisposes the testis to torsion. While not as common, it can also occur late into adult hood. Because the testicular salvage rate is time dependent, prompt recognition and diagnosis is an essential skill of the emergency provider.  In this month's feature film, Dr. Jacob Avila busts some myths and misconceptions about testicular torsion. 

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Journal Club October 2017 - Treatment of Acute Low Back Pain

Journal Club October 2017 - Treatment of Acute Low Back Pain

Low back pain is one of the most common emergency department presentations. Though diagnosis is often straightforward, pain management can be a source of frustration for both the patient and the provider, especially as we focus on limiting narcotic prescriptions given the spreading opiate crisis. In an effort to manage pain, practitioners often counsel patients on the use of over the counter medications or discharge them with a prescription, but what is the evidence behind these medications that we commonly use for back pain? For this month’s journal club, we reviewed three articles that studied the use of acetaminophen, NSAIDS plus muscle relaxers or opiates, and corticosteroids for the management of acute low back pain.

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