ARE YOU POSITIVE . . . OR FALSE POSITIVE? IMPROVING YOUR INTERPRETATION OF THE EFAST EXAM

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ARE YOU POSITIVE . . . OR FALSE POSITIVE? IMPROVING YOUR INTERPRETATION OF THE EFAST EXAM

The EFAST exam is an integral component of an emergency provider’s trauma evaluation. In the right hands, it has a specificity > 90% for intra-abdominal free fluid. There are some pitfalls, however, that can trick the provider into thinking a false positive represents free fluid. In this post, Dr. Gill and Dr. Kring help us improve our EFAST interpretation and recognize these “fake-outs.”

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Analgesics in the ED: What Works, What Doesn’t

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Analgesics in the ED: What Works, What Doesn’t

Prompt, safe, and effective pain management is a core competency of the emergency provider. Unfortunately, traditional strategies for administering analgesics for acute pain have shown poor success rates. In this podcast episode, Dr. Matthew Delaney shares a few evidence based pain management pearls you can use on your next shift.

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Feature Film - Is There Evidence Behind the Management of Spontaneous Intracerebral Hemorrhage?

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Feature Film - Is There Evidence Behind the Management of Spontaneous Intracerebral Hemorrhage?

Spontaneous intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes and affects ~65,000 patients annually in the US. The diagnosis may not be complicated, but the optimal treatment strategy can be a moving target. What is the current recommended blood pressure to limit hematoma expansion? Should we reverse anti-platelet medications? How about seizure prophylaxis? In this feature film, Dr. Siket reviews the evidence behind the optimal management of spontaneous ICH.

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Journal Club April 2018 - Nephrolithiasis

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Journal Club April 2018 - Nephrolithiasis

April’s journal club looked at four clinical questions regarding the diagnosis and expectant course of renal stones. Can the STONE score help you determine if your patient’s flank pain is due to a renal stone? Which is better to confirm your clinical suspicion of a renal stone, ultrasound or CT? How likely will your patient’s kidney stone pass spontaneously? What is the accuracy of hematuria to predict a renal stone in the patient with flank pain?

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Velocity Time Integral (VTI) and the Passive Leg Raise: Taking Volume Assessment to the Next Level

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Velocity Time Integral (VTI) and the Passive Leg Raise: Taking Volume Assessment to the Next Level

Hypotensive patients requiring volume resuscitation are a regular occurrence for emergency physicians. Clinicians are often faced with determining whether patients will respond favorably to IV fluids both before and during vasopressor administration. The ability for point of care ultrasound (including assessment for B lines and IVC collapsibility) to predict volume status and fluid responsiveness has mixed evidence. Here we explore the velocity time integral (VTI), a measurement that can be coupled with a passive leg raise to more accurately assess for true fluid responsiveness.

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Coding in the Community

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Coding in the Community

Coding patients in the community setting is difficult given constraints of man power, specialists, equipment, and other resources. Knowing how to code a patient well in the community is a skill all EM practitioners should master. In this post we review the priorities and pitfalls of coding in the community, with our guest Salim Rezaie.

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Beyond Burnout: Physician Depression and Suicide

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Beyond Burnout: Physician Depression and Suicide

The statistics on physician suicide are frightening. Each year approximately 400 physicians commit suicide. That is more than one per day and roughly the equivalent of two entire classes of graduating medical students. Suicide accounts for 26% of deaths among physicians aged 25-39 - more than twice (11%) that of same age group in the general public. When screened, approximately 10% of medical students and physicians report current suicidal thoughts. Why are these numbers so high in the medical profession? Dr. Casey MacVane helps shed some light on this neglected crisis and what we can do to help our suffering colleagues.

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