NG Lavage: Indicated or Outdated?

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?

(more…)

By Salim Rezaie, MD|2019-09-10T13:37:53-07:00Apr 9, 2013|Gastrointestinal|

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?

(more…)

By Salim Rezaie, MD|2019-09-10T13:37:46-07:00Apr 4, 2013|Cardiovascular|

With Dr. Jeff Tabas giving a lecture on the perennially hot topic of pulmonary embolism (PE) at the upcoming UCSF High Risk EM Conference (main link, PDF Brochure) in San Francisco May 22-24, 2013, I thought I would get a sneak peek into his discussion points.

Rivaroxaban for Pulmonary Embolism: One pill and done?
By Prathap Sooriyakumaran, MD and Jeffrey Tabas, MD
UCSF-SFGH Emergency Medicine (more…)

By Michelle Lin, MD|2018-08-23T19:16:55-07:00Apr 3, 2013|Cardiovascular, Pulmonary, Tox & Medications|

Is ATLS wrong about palpable blood pressure estimates?

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

(more…)

By Salim Rezaie, MD|2017-02-13T14:56:13-08:00Mar 31, 2013|Trauma|

Chest Pain: What is the Value of a Good History?

Every year there are 6 million visits to the Emergency Department (ED) for chest pain, and approximately 2 million hospital admissions each year.¹ This is approximately about 10% of ED visits and 25% of hospital admissions with 85% of these admissions receiving a diagnosis of a non-ischemic etiology to their chest pain (CP).² This over triage has enormous economic implications for the US health care system estimated at $8 billion in annual costs.

(more…)

By Salim Rezaie, MD|2019-09-10T13:37:37-07:00Mar 28, 2013|Cardiovascular|

Venous thromboembolism (VTE) is often treated with low molecular weight heparins (LMWH) such as enoxaparin. For patients with normal renal function, dosing is as follows:

Enoxaparin: 1 mg/kg subcutaneously every 12 hours, or 1.5 mg/kg every 24 hours
Dalteparin 200 IU/kg subcutaneously once daily
Tinzaparin: 175 IU/kg subcutaneously once daily

What about the obese patient? Is there a maximum dose for enoxaparin?

(more…)

By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T18:39:24-08:00Mar 27, 2013|Tox & Medications|

Often finding a pelvic examination bed for a female patient needing a speculum exam can be challenging. Without the elevated foot stirrups, the bed under the patient’s buttocks obstructs the pelvic speculum handle so that it can’t rotate completely into a 6 o’clock position.

Some people place an upside-down bed pan to elevate the patient’s buttocks slightly in order to create more space for the speculum. Not only is the position uncomfortable for the patient, it seems a waste of a perfectly good bed pan. Fortunately there is an alternative approach.

(more…)

By Michelle Lin, MD|2019-01-28T22:00:26-08:00Mar 26, 2013|Ob/Gyn, Tricks of the Trade|

Previous 1···141 142 143 144 145 146147148 149 150 151 152 153···183 Next