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

Dislocated Jaw? Bite Down on This Syringe!

by @JoePinero The next time you have a patient with a dislocated jaw, hand them a 5cc or 10 cc syringe and tell them to stop, drop, bite and roll!Read more

I’ve Got the Black Lung Fluke

Post by @JoePinero 25 yo M no phx, from Ecuador, in US for 6 months, CC 1 month of cough w/speckled hemoptysis, +intermittent subjective fevers responsive to tylenol/motrin. +Wt loss of 7-10 lb’s in past month. In Ecuador worked as fisherman in a small village. Vitals: 99.9 (oral) 113  130/80  98%RA Gen: Well-appearing, thin male,Read more

Statistics is Boring, Necessary, and We’re All Terrible at It!

A recent study published in JAMA,  “Medicine’s Uncomfortable Relationship With Math: Calculating Positive Predictive Value,” highlighted a massive hole in our education. Out of 24 attendings, 26 residents, and a handful of medical students, < 25% of participants was able to correctly calculate the positive predictive value (PPV) of a test. Thus I thought itRead more

Blood Can Be Very Bad- Systematic Approach to Brain Ct

Post by @FTeranmd Using a systematic approach when reading a brain CT will make you a better doctor Because you only see what you’re looking for. Don’t believe? watch: A simplified and systematic approach to the evaluation of non-contrast brain CT for the Emergency PhysycianRead more

Persistent Cough and Ptosis

Post by @Fteranmd 55 yo M active smoker presents to the ED complaining of months of persistent cough, associated with difficulty reading due to inability to fully open his left eye. Physical exam is remarkable for findings shown in the picture above. Patient is otherwise well-appearing and has normal vitals. A chest x-ray is obtainedRead more

Intra-arrest Goal-directed Monitoring in 2014

Post by @Fteranmd Thinking outside ACLS: Summary slide for conference lecture -Pathophysiology of Cardiac Arrest- more

55 F W/ Headache, Aphasia and Low-grade Fever

Post by @FTeranmd 55 yo F with PMHx of asthma who presented to the ED complaining of headache, low grade fever and word-finding difficulty. On further interrogation, patient endorsed having eaten Brie cheese recently. Her medications included albuterol and inhaled fluticasone. In the ED patient was uncomfortable-appearing, with VS: T 101, HR 105, BP 130/70,Read more