Yet Another Scary Ekg Finding…

@JoePinero As if there weren’t enough morphologies and subtleties in the EKG, here is another ekg finding that you should be aware of… de Winter T-waves 1-3 mm ST-depression upsloping at the J-point in the mid precordial leads leading to tall symmetric T-waves No large studies on the topic Several small case series show correlationRead more

Complex Regional Pain Syndrome

@JoePinero 50 yo M hx of NIDDM, recent left shoulder surgery x 4 mo ago for rotator cuff tear, currently presenting with left arm pain from shoulder to hand with swelling and tightness of the left hand and fingers. Exam: Well-appearing male holding his left arm at his side with obvious swelling to the handRead more

Don’t Forget About the Kids….

@JoePinero Quick Case: 17 mo M child presenting with painless bright red rectal bleeding x 1 day. Benign physical exam. Afebrile, with stable vitals and normal labs. Dx: Meckels Diverticulum T99 scan for diagnosis (Sensitivity 85-97%, Specificity 97%) Surgical treatment: Indicated in severe cases, significant blood loss, persistent abdominal pain, refractory to medical treatment. MostRead more

Prisoners Can Refuse Care Too

@JoePinero Prisoners can often cause a lot of ethical dilemma’s when attempting to treat them in the hospital setting. Often times, physicians are reluctant to allow prisoners to sign-out AMA. However, there have been several supreme court cases in the past that have set a solid precedent for allowing this. In brief, here is anRead more

Cardiology Board Questions

1. Which of the following is the earliest EKG finding in acute MI? A. hyperacute T waves B. ST elevation C. ST depression D. T wave inversion E. Q wave 2. Which of the followingis true regarding pediatric EKG analysis? (A) Left axis deviation is normal in healthy neonates. (B) Atrial fibrillation is the mostRead more

No Sir, You Cannot Eat or Drink While in the Ed

@JoePinero – Much literature has been devoted to the attempt of proving the benefit of fasting as it relates to dangerous aspiration events during intubation or procedural sedation. Despite an overwhelming amount of literature pointing out a lack of benefit to fasting, most radiologist and anesthesiologists are very upset if they find out that theirRead more

Cannabinoid Hyperemesis Syndrome

@JoePinero – Cannabinoid hyperemesis syndrome (CHS) is a rare diagnosis to make but can save a lot of time and frustration if you can make it. It is typically seen in young males who are frequent users of marijuana, presenting with severe abdominal pain and vomiting, likely with numerous prior visits all with negative workRead more

Rockall Score for Gib

@JoePinero GI bleeds have been a subject of significant research over the past decade. Let’s review the Rockall risk stratification tool. RISK STRATISFICATION TOOL ROCKALL SCORE: Score > 3 = good prognosis (rebleed < 11%, mortality < 3%) Score > 8   (rebleed < 42%, mortality < 42 %) Vreeburg E, Terwee C, Snel P,Read more

You Put in a Femoral Tlc, You Dirty Dog Didn’t You!

@JoePinero Every critical care physician scoffs at the idea of placing a femoral central line, but are they correct? Do femoral central lines actually cause more infections than other sites?Read more

I Can’t Turn Left…

@JoePinero A 40 yo M hx of HTN, HLD, DM, PVD, who can’t turn left, is not Derek Zoolander, he’s a man having a stroke!  KNOW YOUR STROKE SYNDROMES!!! As we know, this is a favorite topic of the boards, and will time and again be asked on each board/in-service exam. So lets review someRead more