Blog

Cervical Artery Dissection

Cervical artery dissection (CAD) accounts for 1-2% of all ischemic strokes but 10-25% of strokes in younger individuals.  CAD includes extracranial carotid and vertebral artery dissections.  A review of the literature suggests that there may be a significant risk of recurrence in subsequent years.  At this time, it is unclear whether an anti-platelet or anticoagulationRead more

Opioid Substitution Therapy

ED physicians need to be comfortable with the various modalities of opioid substitution therapy (OST) and their associated complications.  We are all familiar with the patient who has missed a daily dose of methadone on the way to booking and is subsequently brought to the ED by corrections officers to address this issue.  A recentRead more

Use the HEART Score

There are approximately 8 million ED visits annually in the United States for chest pain. 10%-20% go on to receive an acute coronary syndrome diagnosis. The goal of the ED physician is to differentiate between ischemic chest pain and other, more benign causes of chest pain. Historical features and laboratory values are helpful, but 2%-5%Read more

Permissive Hypotension

Resist the urge to administer a large crystalloid bolus in hypotensive trauma patients. Doing so worsens coagulopathy and acidosis. This practice should be abandoned. Normotensive trauma patients need no fluid resuscitation. The practice of permissive hypotension in trauma improves has been demonstrated to improve morbidity and mortality (selected references below). Hypotensive trauma patients require surgicalRead more

PE Risk after Induced Abortion

It’s well known that the risk of venous thromboembolism is increased during pregnancy.  It is thought to be two-to-six times higher than the risk in non-pregnant women.  However, these risk estimates are based on pregnant populations that go on to deliver a baby.  Last year Ray et al. published a paper describing their findings onRead more

Bag Mask Ventilation During Intubation

A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study the use of bag-mask ventilation to prevent hypoxemia during intubation.  401 patients were randomized to either bag mask ventilation or noRead more

Gastric Emptying for Acute Poisonings

At the request of department leadership, we will be revisiting methods of gastric decontamination for today’s pearl.  Two methods in particular. Ipecac-induced emesis and gastric lavage are two procedures that we read about in medical school and in textbooks but never utilize in practice.  They are both considered techniques of “gastric emptying” (GE) as opposedRead more

Pacemakers Review pt. 3

Today we will review complications associated w/ implanted pacemakers that you may encounter in the ED and thus ought to be familiar with. Generally, complications can be divided into two categories: early vs. late Early complications typically occur in the first 6 weeks and are related to the implantation procedure itself: venous access, lead positioning, tissueRead more

Pacemakers Review Pt. 2

Cardiac pacing as an intervention can be conceptualized as addressing problems in electrophysiological conduction and/or.  So, for example, if there is a disruption in the electrical continuity between the atrium and the ventricle, a pacer maybe function by detecting a normal sinus impulse in the atrium (there is typically a right atrial lead connected toRead more

Pacemakers Review Pt. 1

The pursuit of mastery over cardiovascular emergencies demands a rough familiarity with implanted devices which includes why they get implanted in the first place (indications), how they work, how they malfunction, and how they affect the EKG., among other features. Today we’ll we’ll start with the basics of implanted pacemakers including indications, anatomy, and radiography.Read more