Paucis Verbis: GRACE score for ACS risk stratification

ChestPain Risk stratification of the undifferentiated chest pain patients in the Emergency Department continues to  plague emergency physicians. It’s partly the reason why I created a TIMI risk score card for unstable angina and non-ST elevation MI in 2010.
Have you heard of the 9-variable GRACE risk stratification score? Thanks to Jeff Bray (physician assistant in a rural critical access ED), I have now. He graciously shared his personal reference card on this with me, which I only minimally reformatted to fit my Paucis Verbis card dimensions.


By |2019-02-19T18:21:15-08:00Apr 13, 2012|ALiEM Cards, Cardiovascular|

Modern EM: Case #4 – Palpitations

Case # 4: Palpitations

A 25 year old woman presents with palpitations, sweating, and shortness of breath since this morning. 6 days ago she had syncopized, was shocked out of V-tach by EMS, and eventually had a defibrillator placed for an unknown arrhythmia. Now, she feels her heart beating in her chest, looks diaphoretic, is tachypnic, but her pulse is 58 and regular.


By |2016-11-18T10:03:19-08:00Apr 9, 2012|Cardiovascular, Social Media & Tech|

Paucis Verbis: Lead aVR on EKG


What lead is the most overlooked on the EKG?

 Answer: aVR

Lead aVR can provide some unique insight into 5 different conditions:

  1. Acute MI
  2. Pericarditis
  3. Tricyclic antidepressant (TCA) and TCA-like overdose
  4. AVRT in narrow complex tachycardias
  5. Differentiating VT from SVT with aberrancy in wide complex tachycardias by using the Vereckei criteria (possibly better than Brugada criteria)


By |2018-01-30T02:05:17-08:00Nov 18, 2011|ALiEM Cards, Cardiovascular, ECG|

Paucis Verbis: An approach to persistent tachycardia

Tachycardia is a common clinical occurrence in the ED. Most of the time the etiology can be discerned through the history and physical exam, but sometimes it cannot. This is problematic especially when we are about to discharge a patient home but his/her heart rate is still 115 beat/min. We can’t send this patient home yet. Do we then have to admit them for work-up of persistent tachycardia?

By |2017-08-03T00:24:05-07:00Aug 19, 2011|ALiEM Cards, Cardiovascular|

Paucis Verbis: Fibrinolytics for PE


When would you give fibrinolytics for a Pulmonary Embolism?

This Paucis Verbis card summarizes recommendations found in Circulation’s recently published Scientific Statement from the American Heart Association. Although it is rare to give fibrinolytics for a pulmonary embolism (PE) in the Emergency Department, it is important to remember when lytics are indicated.


By |2017-08-03T00:46:18-07:00Jul 29, 2011|ALiEM Cards, Cardiovascular, Pulmonary|

Paucis Verbis: Cardiac tamponade or just an effusion?

cardiac_tamponadeWhat is a cardiac tamponade? It is a clinical state where pericardial fluid causes hemodynamic compromise. With bedside ultrasonography in most Emergency Departments now, it’s relatively easy to detect a pericardial effusion.

But what we more want to know in the immediate setting is: Is this cardiac tamponade?

You can look for RA systolic or RV diastolic collapse. What if it’s equivocal? How good is the clinical exam and EKG in ruling out a tamponade?


By |2019-01-28T22:41:46-08:00Jul 8, 2011|ALiEM Cards, Cardiovascular, Ultrasound|
Go to Top