At my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 1 looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment.
“Done Fell Out”, or DFO, is a common saying in the South to describe syncope. Although the saying is funny the diagnosis is not. Syncope accounts for about 3–5% of ED visits and 1–6% of hospital admissions. In patients >65, syncope is the 6th most common cause of hospitalization.
How do you approach the management of patients with syncope?
It is well known that taking a good history and physical, getting a non-ischemic EKG, and serial cardiac biomarkers, results in a risk of death/AMI of <5% in 30 days. Patients, in whom you still suspect have CAD, should undergo provocative testing within the next 72 hours based on the AHA/ACC guidelines. Their guidelines deem provocative testing as including:
- Exercise treadmill stress test,
- Myocardial perfusion scan,
- Stress echocardiography, and/or
- Coronary CT angiography (CCTA).
Nasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence support the logic? Most studies state that endoscopy should occur within 24 hours of presentation, but the optimal timing within the first 24 hours is unclear. Rebleeding is the greatest predictor of mortality, and these patients benefit from aggressive, early endoscopic hemostatic therapy and/or surgery. So what are the arguments for and against NGL?
As I am getting into my 3rd year of practice as a faculty in Emergency Medicine and Internal Medicine, I have begun to wish I had a better framework for success in academic medicine. Currently, almost on a daily basis, I have to answer about 100 emails, decide if I want to be on different committees, develop curricula, give lectures, do research, work clinically, mentor residents/medical students, and have a work-life balance. Does this sound familiar, and at the same time overwhelming?
Recently I read several articles on this very topic and thought maybe I would give some perspective on useful strategies to succeed in academic medicine, get recognized, and still have that healthy work-life balance.(more…)
Hospital admissions for chest pain often incur costly and resource-intensive workups for ACS. Is there a way to identify a low risk group who can be discharged home in a timely manner, without further workup, and without short-term adverse events from ACS?
In Advanced Trauma Life Support (ATLS), we learned that a carotid, femoral, and radial pulse correlates to a certain systolic blood pressure (SBP) in hypotensive trauma patients. Specifically ATLS stated:
- Carotid pulse only = SBP 60 – 70 mmHg
- Carotid & Femoral pulse only = SBP 70 – 80 mmHg
- Radial pulse present = SBP >80 mmHg