Blog

Lewis Leads & Invisible P’s

You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a manner that basically triangulates atrial activity to help make the p-waves of your EKG more prominent. Lead placement includes the RARead more

Head Scratcher of a Head CT?

Hey there guys and gals and welcome back to my channel! If you’re like me and TERRIBLE at reading your own imaging studies, settle in for a quick 20 minute run down for all those CT heads everybody be ordering without a second though. But before we get into it, don’t forget to like andRead more

Clinical Decision Support…your daily helper.

Continuing with the theme of clinical informatics, today we will touch on the topic of Clinical Decision Support Systems (CDSS), or sometimes just called Clinical Decision Support (CDS). The basic premise of clinical decision support is that it delivers timely and useful patient/disease/ or treatment-related information in an organized manner, with the goal of improvingRead more

What Is Clinical Informatics?

If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? Shall we begin? According to the Oxford dictionary: Informatics is the science of processing data for storage and retrieval. In theRead more

Cerumen Impaction: an Update.

The last time www.sinaiem.org addressed the topic of cerumen (ear wax) impaction was in 2013. See this post: http://sinaiem.org/50yo-man-with-chest-pain-and-also-with-r-ear-pain/  If you’re like me, you likely believe that the world of cerumen impaction is a rather static one. Given that, another post on cerumen impaction would seem to be duplicative…Well you (and I) are wrong, and here’sRead 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

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