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Serial Troponin for Atypical Symptoms? – PART III

Serial Troponin for Atypical Symptoms? – PART III In general, the literature suggests that elderly patients who present with atypical chest pain should receive at least two troponins for several reasons: 1) though there are many practical reasons to order a single troponin measurement in the ED, the practice of doing so for patients atRead more

Single Troponin for Atypical Symptoms? – PART II

This is part two of a three-part series to answer the question, “it is acceptable to order a single troponin in an elderly patient with dizziness, weakness, or a similarly vague anginal equivalent?” So far, we understand that troponin testing can be tricky, and while it’s common clinical practice to order a single troponin, only serial troponinsRead more

Single Troponin for Atypical Symptoms? – PART I

You’re working in Geri and have 10 elderly patients with dizziness and/or SOB on your board. None of them can reliably recall when their symptoms started. You are about to order “just one trop” on all of them. After all, elderly patients have atypical presentations of ACS, right? And most of them have cardiac risk factors includingRead more

Elevated Lactate: Significance and Challenges

Given the evolving definition of sepsis and the continual push to report sepsis measures to State Health Departments and CMS, I thought the time is ripe to revisit a popular topic: the significance of elevated lactate in the ED. After all, not all elevated lactate is sepsis, and we may be able to spare someRead more

How a Chest Tube Drainage System Works

If you’re like me, you probably hook your chest tube up to a Pleur-Evac, put it on the ground, then back away slowly. Who knows what goes on in that mysterious bubbling white box? Hopefully this will post shed some light. Isn’t this just a container for stuff that comes out of the chest? WhyRead more

Staying Cool: An Overview of Therapeutic Hypothermia

If you’ve ever been confused about why cooling matters in post-cardiac arrest, when to do it, how to order it, or what temperature (34C? 36C?) is best, read on. Why do we do this? To protect the brain from the effects of poor profusion due to cardiac arrest. There is good evidence that hypothermia slowsRead more

Glucagon for Beta Blocker Overdose

When Should I Use It? For cases of profound beta blocker overdose with clinically significant cardiovascular depression (symptomatic bradycardia, hemodynamic instability). Since many patients are on both beta blockers and calcium channel blockers, it can sometimes be difficult to tell which was the source of overdose. One hint is that beta blocker overdose tends toRead more

The K2 Chameleon

This Tuesday, the New York Times reported that 33 patients from the same Brooklyn neighborhood were transported to the ED due to a “bad batch” of K2. But what is a “bad batch,” and what does it mean in terms of treatment in the ED? The frightening truth about K2 is that there is no such thingRead more

Safe Discharge for Undifferentiated Abdominal Pain

Abdominal pain is the most common chief complaint in the emergency room, yet up to 40% of these patients are discharged without a definitive diagnosis. In cases of nonspecific abdominal pain, it is crucial to have a meaningful discussion about discharge with the patient and document a robust discharge assessment. A safe discharge for nonspecific abdominalRead more

Fireworks: Facts vs Fiction

On account of the holidays, we’re starting July off with a bang with a Triple Pearl. There is a significant increase in firework-related injuries this time of year, but the distribution of injuries may surprise you. If you’re expecting to see a bunch of teenagers blowing their hands off, or intoxication related injuries, think again.Read more