Takotsubo Cardiomyopathy: The Octopus Trap

Takotsubo Cardiomyopathy was first described in Japan in 1990 and in the United States in 1998. It was named after an octopus trap (“tako-tsubo”) due to the shape of the trap being similar to the appearance of the left ventricular (LV) apical ballooning that occurs in this condition. Why is this condition so important to know? It can mimic acute coronary syndrome and most patients go to the emergency department because they are worried they are having an acute myocardial infarction.

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By Salim Rezaie, MD|2019-09-10T13:39:35-07:00Jul 11, 2013|Cardiovascular, ECG|

Trick of the Trade: Stimson technique using wrist restraints

A patient presents with an anterior shoulder dislocation on x-ray. Your ED just received 5 new patients via ambulance and you are trying to prioritize your patients as they come in the door. What can you do for your patient with the shoulder dislocation in the meantime? (more…)

By Michelle Lin, MD|2016-11-11T19:02:30-08:00Jul 10, 2013|Orthopedic, Tricks of the Trade|

Prehospital ECG and STEMI Activation: A Good Idea?

It is well known that primary percutaneous coronary intervention (PPCI) is the gold standard in STEMI treatment and that decreased door-to-balloon time has better patient outcomes. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) should be 90 minutes or less.

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By Salim Rezaie, MD|2019-09-10T13:39:30-07:00Jul 9, 2013|Cardiovascular, ECG|

The Importance of Reciprocal Changes in Lead aVL

ECG interpretation is one of the most important skills to master as an emergency physician, and its interpretation can be very complex and frustrating. ECG manifestations can be very subtle, and sometimes the earliest and only ECG change seen will be reciprocal changes alone. To further complicate this, many patients have the atypical symptoms of nausea/vomiting, weakness, or shortness of breath and not chest pain.

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By Salim Rezaie, MD|2019-09-10T13:39:23-07:00Jul 3, 2013|Cardiovascular, ECG|

LET’S START WITH THE FACTS

We know that calcium chloride (CaCl₂) provides 3 times more elemental calcium than an equivalent amount of calcium gluconate.
So, CaCl₂1 gm = calcium gluconate 3 gm.

CLINICAL QUESTIONS

Does CaCl₂have better bioavailability than calcium gluconate?
Does calcium gluconate have a slower onset of action because it needs hepatic metabolism to release the calcium?

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T18:39:24-08:00Jul 2, 2013|Tox & Medications|

Geriatric Blunt Trauma – Respect the Lactate

Which is a better prognostic tool in geriatric trauma, traditional vital signs or lactate level?

Meet Norma Nuance (NN), a 70-year-old woman with CAD, HTN, HLD, DM, and mild dementia. She was involved in an MVC as the restrained driver with questionable LOC. She arrives in your ED and appears confused, but has a history of dementia. There are no family members to tell you her baseline. Her BP is 120/80, and her HR is 90. She is not calling out in pain, but does mumble about her left arm when you ask if she is hurting. You think she may have sprained her wrist.

Now meet Frankie Obvious (FO), a 22-year-old male, who was the helmeted driver of a motorcycle that hit a car. He was thrown from the motorcycle, and arrives combative and yelling with a HR of 130 and a BP of 100/70.

Based on their vital signs, which patient is going to receive more immediate attention? Your lactate level is pending… (more…)

By Christina Shenvi, MD, PhD, MBA|2017-03-05T14:18:36-08:00Jul 1, 2013|Geriatrics, Trauma|

Patwari Academy videos: Anticoagulation and reversal agents

Bleeding in general is bad. Bleeding while on anticoagulants is VERY bad. Dr. Rahul Patwari reviews the pathophysiology of coagulation, the various reversal agents, and treatment approaches we can use. In this five-part series where all videos are less than 10 minutes, Rahul goes from the basic physiology of coagulation all the way to the complex reasoning and approaches to reversing anticoagulants. These are worth a quick look and review.

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By Michelle Lin, MD|2019-01-28T21:57:58-08:00Jun 30, 2013|Heme-Oncology, Patwari Videos, Tox & Medications|

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