Oxygen for STEMI: Saving lives or Blowing Hot Air

We’ve all seen the patients roll in with EMS nasal cannula snug against their nares. “Why are they on oxygen?” EMS response, “I don’t know he was having chest pain.” EKG shows STEMI! The last thing you’re thinking is whether their nasal cannula should be adjusted but maybe they don’t need the oxygen at all.Read more

What Diagnosis Lies Beneath? Medical Legal Basics

Seeing our alumni at ACEP was amazing! It seems like Life after Residency is sweet: making your own schedule, working with great colleagues, no more pushing people to CT, developing startups! The sky is the limit but then there’s the inevitable question, the question that lurks in the back of my mind since days ofRead more

EKGs that make you go Hmmm: Toxidrome EKGs

Overdose and EKGs they start to all look the same…widened QRS, that thing in aVR…vfib (hopefully not). Here’s a highlight of key EKG findings associated with a few toxidromes: (1) Bupropion overdose (2) TCA overdose (3) Digoxin Toxicity Bupropion Overdose: See wide-complex tachydysrhythmias-widened QRS and QT intervals; case reports have shown cardiogenic shock Consider inRead more

Compartment Syndrome: UNDER PRESSURE

Dr. David Forsh’s review yesterday of compartment syndrome made me realize how rarely we see this life-threatening diagnosis. So what do we need to know? What’s the etiology of compartment syndrome? Majority cases 2/2 Fractures (75%); the rest are soft tissue injuries from causes such as: snake bites, seizures, burns, tourniquets,… People with coagulopathy suchRead more

1 hour Troponin: The new TnT for Chest Pain?

Chest pain…everyone gets it…sometimes when a patient says they have chest pain I get chest pain. What’s the solution to this chest pain epidemic? Troponins! Well not so fast because they aren’t fast…especially when the lab tells you, “no troponins here…” Dr. Jean Sun Reviewed Troponins beautifully in her posts Troponins Part I, Part II,Read more

ED AGITATION: Let the Bodies Hit the Floor

Have you ever had those patients that are agitated? In a Zombie-like frenzy they rip out all their lines and extubate themselves in the CT scanner agitated? I think we’ve all been there (hopefully with something for sedation in hand!). Dr. Reuben Strayer highlighted how to handle these patients well in his 2016 SMACC talk.Read more

Antibiotics + Abscesses: To I&D and Beyond!

So you’ve I&D’d that abscess, there’s no surrounding cellulitis you’re ready to Treat em’ and Street em’ but the patient asks: “Can I have some antibiotics, please? And maybe a sandwich?” [you probably make the face above right?] Well what a recent study by Talan et al (2016) found is that the answer to thatRead more

Modified Sgarbossa Criteria: the Post-Y2K solution

Left Bundle Branch Blocks (LBBBs) are scary because they can be confused for MIs and MIs are scary…almost as scary as Y2K. Which takes us back to the 90s…the good days, good music, great hairstyles, and Sgarbossa! 20 years ago we devised a rule to help distinguish a newly identified LBBB from MI, but in ourRead more

Bedside Sono for DVT: Will it ever see the light of day?

Bedside sono for DVT: Ready for primetime? You got a patient with an enlarged, red, angry leg. It screams sono me for DVT! It is midnight and radiology tells you it cannot be done until the morning. Can YOU sono the patient? Technically yes…we have an ultrasound and bedside sono’s for DVTs are easy right?Read more


  Dr Smith ECG blog: note STD in inferior leads and STE in V1 and V2 “Brugada-like pattern” Dr. Smith ECG Blog: note peaked T waves Ours Truly: widened QRS, disappearance of PR intervals, interventricular conduction abnormalites with PVCs…badness                     What do all these EKGs haveRead more