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Are Acetaminophen Levels Necessary in All Overdose Patients?

pills SS (1)ExpertPeerReviewStamp2x200Intentional overdose patients are notorious for giving inaccurate histories. “I took 14 tablets of this and 8 capsules of that. No, wait. It was 3 tablets of this and a handful of capsules of that… This happened about 2 hours ago. Actually, I think it was last night.” Round and round the merry-go-round we go.

  • How should we risk-assess whether acetaminophen is involved? 
  • If the patient provides no history of acetaminophen ingestion, do we need to order a level?

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By |2016-11-11T19:02:49-08:00Sep 4, 2013|Expert Peer Reviewed (Clinical), Tox & Medications|
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Alcohol Problems Among Older Adults in the ED

The complications of alcohol use can be subtle in older adults, and the effects of alcohol are often incorrectly attributed to aging. Because of its under-recognition, the barriers to screening, and the many subtle ways in which it can present, some have suggested that alcohol misuse has replaced syphilis as the “great masquerader”. If you don’t think alcohol misuse is a problem among older adults in your ED, it may be because it has been hidden in plain sight.

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By |2018-10-28T21:20:58-07:00Sep 2, 2013|Geriatrics, Tox & Medications|
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Bundle Branch Blocks (BBBs) 101

722px-Electrical_conduction_system_of_the_heartRecently, I have been asked by several students at my home institution (UTHSC at San Antonio) to help them understand bundle branch blocks.  This is different than some of my usual posts because it is meant to be more educational than evidence based.  So here we go.  The normal conduction system of the healthy heart is shown to the right.  If there is a delay or block in the left or right bundle, depolarization will take longer to occur. Therefore we get a widened QRS (>0.12 sec or >3 small boxes).

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By |2019-09-10T13:36:03-07:00Aug 29, 2013|Cardiovascular, ECG, Expert Peer Reviewed (Clinical)|
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R-Wave Peak Time (RWPT) in Lead II: One Simple Step to Differentiate Wide Complex Tachycardias

RWPT-VT-2There are several algorithms that are currently used to help distinguish Supraventricular Tachycardia (SVT) with aberrancy and Ventricular Tachycardia (VT). Many of these algorithms lack specificity, and let’s face it, who can remember if the absence of an RS complex in the precordial leads is VT or SVT with aberrancy. So what if there was a criterion that had a good sensitivity (SN), specificity (SP), and was one simple step?

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By |2019-09-10T13:36:27-07:00Aug 28, 2013|Cardiovascular, ECG|
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PV Card: Brugada Criteria for SVT with Aberrancy vs Ventricular Tachycardia

2011_04_22Awm

Due to the overwhelming popularity of Dr. Salim Rezaie‘s recent post discussing the Brugada criteria for  SVT with aberrancy vs VT, Dr. Jason West (@JWestEM, an EM resident from Jacobi/Montefiore) kindly helped to co-author and package this information into a PV card for quick reference. To use this sequential, four-question approach, if at any time you answer YES to the question, it is ventricular tachycardia.

PV Card: SVT vs VT – Brugada Criteria


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Brugada P, Brugada J, Mont L, Smeets J, Andries E. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83(5):1649-1659. [PubMed]
By |2021-10-06T19:47:10-07:00Aug 27, 2013|ALiEM Cards, Cardiovascular, ECG, Expert Peer Reviewed (Clinical)|
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Ultrasound-Guided Pericardiocentesis

pericardial tamponade ultrasound pericardiocentesis

All the years of ultrasound training in residency has paid off. You found the large pericardial effusion in the hypotensive patient who is still alive, but looks sick. You are a star! The only problem was that you never performed a pericardiocentesis in an awake patient. The cardiology fellow is at home sleeping and/or the closest receiving hospital is about 1 hour away. Now what?

Dr. Arun Nagdev reviews how to do an ultrasound guided pericardiocentesis as part of this new, ongoing series of advanced ultrasound tips for emergency physicians.

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By |2022-10-10T14:36:37-07:00Aug 22, 2013|Cardiovascular, Ultrasound|
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