What do I need to assess before I load this patient in the heli?
The Sick Patient with Pulmonary Artery Hypertension (PAH)
Case 1: Troponin Use in ESRD
ST-elevation in 2 contiguous leads that is:
Men < 40: 2.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
Men > 40: 2.0 mm ST-elevation in V2 or V3, 1 mm in any other lead
Women: >1.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
STEMI's have a 90-minute door-to-balloon time mandate from the Center for Medicare Services (CMS). To be good stewards of our resources we need to be familiar the false positive STEMI patterns. Ultimately, however, some degree of over triage and activation for false positives is expected and (potentially even) desirable.
Read More1) On Technology, Emergency Medicine, and New Frontiers
Today’s tech explosion is leading to health innovations that may make some big differences leading to big changes. Here’s a sneak peak:
In the near future drones may roam the sky to deliver life saving epi pens, defibrillators and instructions of how to use them. Until SkyLab takes over...
Portable ultrasound? Pocket VL? (Hey don't we already have those...)
CHEER Trial: Too young to die? Try ECMO. Australia did and in a trial of 26 people, 14 went on to live and many with excellent neurologic recovery.
TEE: A small number of point of care ED docs are using this successfully to better evaluate causes of shock with good results, low risks (0.03% perf rate), and little training
Thromboelastography (TEG) measures the dynamics of clot development, stabilization/strength, and dissolution. Assuming the body’s ability to achieve hemostasis is a function of these clot properties, TEG provides specific, real-time indicators of a patient’s in vitro hemostatic state. This is in contrast to routine screening coagulation tests such as aPTT and PT/INR which are run with blood plasma alone and therefore do not take into account the cellular components of clotting.
Read MoreIncidence in the US is 0.5-1% (lifetime risk 10-15%). There is a 2:1 male predominance and the recurrence rate is fairly high (37% at 1 year, 50% at 10 years and 75% at 20 years).
Patients at risk for poorer outcomes with ureterolithiasis are those with risk factors for diminished renal function, history of difficulty with stones/urologic intervention and symptoms of infection.
Read MoreThis is our final recap of our "Out on a Limb" Case Series! If you missed the initial "Moonlighter" case and discussion you can check it out here. There were a number of great responses to the questions which we'll recap below.
You have a few options in handling this situation. As many of the respondents chimed in, the wound definitely needs to be cleaned out and closed and the patient requires antibiotics as soon as is reasonably and safely possible, especially since the injury is already 6 hours old. The first option is to complete a sedation and multilayer repair in the ED yourself. As many people point out, this is not an excellent proposition unless there are extreme extenuating circumstances.
Read MoreThe responses provided so far have been phenomenal, both insightful and provocative. I am truly impressed. As mentioned by several of my colleagues, many of these cases are deeply personal, not only because they involve highly vulnerable populations, but also because they may put clinical providers in harm’s way. When we begin to discuss ethics, especially global health ethics, there is often no single correct answer to a given scenario. We often deal with hard science and hard facts but sometimes you just have to go with your gut and do what you think is right. If you missed the first case and initial discussion, check it out here.
Read More"Give me six hours to chop down a tree and I will spend the first four sharpening the axe" - Abraham Lincoln
In order to lead the team, you need a reflection of what you need to improve as a leader:
African Tick Borne Illness
Hypothermic cardiac arrest
SRU (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.
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