It's late into your shift when a 12 month-old rolls into your trauma bay and have reproducible abdominal pain. Do you go straight to CT? LFTs? UA? Dr. Shan Modi takes us through the literature and utility of laboratory studies and EKGs in pediatric trauma.
Read MoreLast week we introduced to you a primer on the interpretation and detection of heart blocks on EKGs. Now you can test out your knowledge with some cases based on the information in the previous post!
Read MoreWe order and interpret numerous EKG’s during our shifts in the emergency department. EKG interpretation is one of the skills we need to be competent in and comfortable with as an emergency medicine physician. STEMI’s, ischemic changes and arrhythmias are some of the most important findings we focus on, and although straightforward, heart blocks can be easily overlooked. The goal of this post is to go over some of the most common and clinically relevant conduction blocks, how to manage them and what their disposition are.
Read MoreProcalcitonin was reviewed on Taming the SRU in the context of other biomarkers (ESR, CRP) last year with a grand rounds discussion of its utility in the setting of a febrile 7 week old. As procalcitonin has continued to gain traction in the world of pediatric EM – receiving evaluation as part of proposed protocols for management of febrile infants (1) and for its utility as an aid to diagnosis of Serious Bacterial Infection (2,3) – we turned our attention this year to procalcitonin’s use in adults. Procalcitonin testing has been studied and available for decades (as St. Emlyn’s noted in an update earlier this year), but has not really established itself in widespread use in adults (as EMDocs noted in a sepsis update in 2014). In this blog post, we take the approach of going back to what is known (and is NOT known) about the biochemical basics of this molecule to give context to the sometimes confusing smorgasbord of proposed applications for procalcitonin testing that exists in the literature.
Read MoreIn March 2015, Dr. Renne did a Grand Rounds lecture on soft tissue neck radiographs, which offers a great review of normal anatomy and systematic approach to reading films (“CHESS”). Yet, in my small, informal (not scientific at all) poll of some of our residents, none had ever ordered a soft tissue neck film. Are soft tissue neck radiographs useful? You be the judge.
Read MoreIt’s a typical shift in your community shop when you see a patient on the board that makes you nervous. 2 year old male with syncope. It’s been awhile since you have treated someone born in the 21st century and you know this child’s workup will likely involve an EKG. The closest pediatric hospital is 2 hours away. How comfortable do you feel interpreting the squiggle lines generated by this little heart?
Read MoreIf the chief complaint of your patient is abdominal pain, altered mental status, overdose, generalized weakness chances are you at least considered ordering a hepatic panel. In fact, studies show that the hepatic panel is the third most common laboratory test ordered in the emergency department only behind the CBC and renal panel. If emergency medicine physicians are so quick to order this test, it is important to also know how to interpret all the little red arrows that often accompany your results. For this we will review each component and even (wait for it) … a little biochemistry!
Read MoreLumbar punctures are common procedures to the Emergency Medical provider. Obtaining the fluid is just part of the battle however with this procedure. With the flood of results often comes a fair bit of confusion as to how to interpret them. After reading this post, you'll be able to:
Amongst the various diagnostic studies that can be obtained in the ED, urinalysis is a virtually ubiquitous test. Urine itself reflects the functioning of the human body in both health and disease and the values it comprises can give us information regarding a myriad of conditions from infections, metabolic or endocrine derangements, and toxidromes to neoplastic processes and pregnancy. Despite this, many of the elements of even the standard urinalysis are often overlooked and underappreciated. In this talk we will explore some of these values and hopefully gain a renewed respect for the “golden cup of answers” and all that it may reveal.
Read MoreReal time, high sensitivity serum biomarkers have played an enormous part in the timely identification and intervention on of cardiac pathology in the Emergency Department. These biomarkers have sufficient sensitivity to identify cardiomyocyte injury even in the absence of physical exam, radiographic, or electrocardiographic findings. Unfortunately, the utility of these studies may be limited or obfuscated in certain clinical contexts. This article will discuss the possible pitfalls and obstacles physicians may encounter in interpreting cardiac biomarkers
Read MoreEver have a patient present with foot or ankle pain? In case you have, here is a refresher on the radiographic anatomy of the foot as well as the test characteristics and viability of the use of the Ottawa Rules in the ED setting by Dr. Golden.
Read MoreParacentesis and thoracentesis are relatively common procedures in the Emergency Department but the analysis of the fluid can always but a touch confusing. In this post, PGY-1 Dr. Michael Klaszky walks us through the analysis of pleural fluid and ascitic fluid.
Read MoreHave you ever wondered what is actually being measured when you order a renal panel/BMP/serum electrolytes? Well grab your nearest pumpkin spice latte and put your Gilmore Girls Netflix binge on pause because we are about to get a little basic . . . science!
Read MoreViral hepatitis is a commonly encountered and increasing problem thanks in part to the rise in injection drug use. Here I review the screening recommendations and interpretation of hepatitis B and C serology. Screening recommendations are based on CDC and US Preventative Task Force guidelines. Prevalence of viral hepatitis is much higher in the ED setting and may warrant expanded screening. This is an active area of research and there are as of yet no formal professional recommendations regarding expanded screening. In this post we will explore the current screening recommendations for HBV and HCV and detail the interpretation of the test findings.
Read MoreAll bleeding stops eventually... Even in your anticoagulated patients? What about that INR of 1.4? On rivaroxaban? To better know the state of anticoagulation we first must understand the tests we use to define them. Take a dive with Dr. Murphy-Crews through our anticoagulation studies
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
