Dr. Rahul Patwari reviews the basics on how to determine an ECG’s rate, rhythm, and axis. It’s always nice to review these concepts. Do you remember how many seconds a traditional ECG typically spans on a single page? What’s the significance of the numbers: 300, 150, 100, 75, 60, 50? Spend a few minutes on these 2 refresher videos.
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EKGs are a simple, cheap modality that can give an emergency physician quite a bit of information. Sometimes, in a busy ER, this information can be very subtle and almost overlooked without a second thought. A perfect example of this is a New Tall T-wave in lead V1 (NTTV1). This finding can be a normal variant, but can also be a precursor to badness.
A fiberoptic nasopharyngoscope is a handy tool to check patients for suspected foreign bodies (e.g. fishbone stuck in throat) or laryngeal edema. Depending on the diameter of your fiberoptic cable, it may be fairly uncomfortable for the patient despite generous viscous lidocaine instillation through the nares and nebulized lidocaine. Alternatively or additionally, you can make your own lidocaine-oxymetazoline nasal atomizer which works well.
What if the patient is STILL not tolerating the procedure well?
Emergency Neurological Life Support (ENLS) is a new online course that I am taking. It is sponsored by the NeuroCritical Care Society, which focuses on the first few hours of care to neurological emergencies. It is a collaborative effort between emergency physicians and neurointensivists, both of which author each individual module. The course is co-chaired by Scott Weingart, MD of EMCrit fame and is geared towards anyone who treats neurological emergencies (physicians, nurses, PA/NP, EMS personnel). The course utilizes technology to deliver its content by podcast, video presentation of ENLS guidelines, online reading of published guidelines and an online quiz. Completion of all modules awards the participant a certificate of certification in ENLS as well as 15 hours of CME. (more…)
Emergency medicine is full of surprises, twists, and turns. We don’t know what type of patient we will encounter prior to a shift, but we are ready for any and all. That being said, preparation is essential prior to the arrival of critical patients. This is why the airway cart is checked before starting a shift or the position of the bedside ultrasound machine is always mentally tracked in order to quickly grab if needed.
Unfortunately, individual preparation is not sufficient for large scale disasters. This level of preparation must happen on a hospital and interdepartmental level such as coordination between trauma surgery, orthopedics, and emergency medicine with agreed upon policies.
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.
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…)