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Thanks to Liz Cho for a nicely presented case of a PE sudden death and lit review of thrombolytics in PE and arrest.

For those of you who missed, (and you know who you are):

Heparin lives in the ED, and can be given IV immediately (Order>nurse> patient).

Lovenox takes a while. (Order,>nurse> tube> pharmacy (who sends it back for dosing adjustment)> tube > BA> nurse> patient)

The literature supports thrombolysis in PE/ shock.

10% of hemodynamically stable patients with RV dysfunction will deteriorate into shock with 50% mortality rate
Patients with RV dysfunction have mortality rate of 9.3% compared with 0.4% with normal RV function.

If you think a patient has RV dysfunction and are considering thromboytics, look at the RV.

Signs of RV dysfunction are RV distention or hypokinesis, paradoxical RV septal systolic motion, RV larger than LV in subcostal or apical view

If you are uncomfortable (most of us may be) evaluating for RV dysfunction, call for echo.

Cardiology has committed to 24/7 cardiac echo; call them if the answer will change your treatment (i.e. thrombolytics).

Consider thrombolytics if suspicion is high for PE as opposed to a bleeding pathology, such as dissection. Thrombolytics in undifferentiated cardiac arrest have not been shown to improve outcome.

Please join us for conference on February 3rd in the 8th floor conference room at Elmhurst. The day begins with journal club - please come prepared!!

9a - Journal Club - Curtis (see articles below)
10a - Procedure Talk - Chiang
1030a - US Case of the Month - Chisolm-Straker
11a - Trauma Conference - Weingart
12p - M&M - Pleasant

Henry has chosen 3 articles to review and requests that everyone comes prepared.Residents as usual the journal articles are behind the normal logon and password.
PGY1s and 2s: Claassen et al. Criminal correlates of injury-related Emergency Department recidivism J Emerg Med. 2007;32(2):141-47. Paper.
PGY3s and 4s: Abbass et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study CJEM. 2009;11(6):529-34. Paper.
All: Lerner and Kobernick. Return visits to the emergency department. J Emerg Med. 1987,59:359-62. Paper.

Thanks to Alan for his look at the utility of FAST exams, incorporating a pioneering study of FAST as well as some more recent work. The three papers he picked are below:

• Rozycki et al. Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries: Lessons Learned From 1540 Patients Ann Surg. 1998;228(4):557-67.
• Miller et al. Not so Fast J Trauma. 2003;54:52–60.
• Schnuriger et al. The accuracy of FAST in relation to grade of solid organ injuries: A retrospective analysis of 226 trauma patients with liver or splenic lesion. BMC Medical Imaging 2009, 9:3.

For a review of these papers, and some resources for FAST, see below!

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Please join us for conference this Wednesday, January 27th, at 9am in Hatch Auditorium. We’ll share lunch, and ideas, with our Psychiatry ED colleagues at noon.

9a - M&M - Dr. Cho
10a - Senior Lecture - Dr. Chiang
11a - Child Abuse - Dr. Paul
12p - Joint Psychiatry ED/ED Conference - Dr. Asaad
1p - OSHA Retest
115p - Pediatric M&M - Dr. Hill

Join us for Airway Day this Wednesday at Elmhurst beginning at 9am.
We will meet in the old psychiatry ED for this day of hands on workshops and important learning.
Please be on time.

Join us and emergency medicine residents from around the city for the annual Critical Care Conference this Wednesday, January 13th. This year we ask the question “What is ED Critical Care?”
We’ll meet in Stern Auditorium beginning at 8:30am. The schedule is below.
Don’t forget to cheer on your Sinai Simulation Wars Team - Dena, Dan and Dan!

8:30a Registration and Breakfast
9a - Introduction
9:10-9:50a - Critical Care in Unconventional Environments - Dr. Kvetan
10-10:40a - Critical Care Articles that Every ED Doc Needs to Know - Dr. Winters
10:50 - 11:20a - You’re Doing it All Wrong - Dr. Weingart
11:20 - 11:40a - BREAK
11:40 - 12:20p - Pecha Kucha Competition - Drs. Andrus, Manoach, Meyers and Strayer
12:20 - 2p - SIM WARS

Please join us for conference on January 6th in the 8th floor conference room at Elmhurst. The day begins with journal club - please come prepared!!
9a - Journal Club - Huang (see articles below)
10a - Procedure Talk - Trivedi
1030a - US Case of the Month - LaCalle
11a - Trauma Conference - Weingart
12p - M&M - Asaad

Alan has chosen 3 articles to review and requests that everyone comes prepared. Residents as usual the journal articles are behind the normal logon and password.
All: Rozycki et al. Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries: Lessons Learned From 1540 Patients Ann Surg. 1998;228(4):557-67. Paper.
Miller et al. Not so Fast J Trauma. 2003;54:52–60. Paper.
Schnuriger et al. The accuracy of FAST in relation to grade of solid organ injuries: A retrospective analysis of 226 trauma patients with liver or splenic lesion. BMC Medical Imaging 2009, 9:3. Paper.