PV card: Ectopic pregnancy
Ectopic pregnancy is the leading cause of maternal death in the first trimester of pregnancy. A recent JAMA systematic review,1 from The Rational Clinical Examination series, looked to risk-stratify women in early pregnancy presenting with abdominal pain or vaginal bleeding for ectopic pregnancy. The authors set out to identify the accuracy and precision of elements in the history, physical examination, beta hCG, and ultrasound in ectopic pregnancy. The systematic review consisted of 14 studies (n=12,101). The search consisted only of English language studies from 1965 to 2012 in which ectopic pregnancy was the final diagnosis with 100 or more patients per article. The [+]
Pediatric Appendicitis: CT or Ultrasound?
Appendicitis is the most common pediatric surgical emergency accounting for 5% of urgent pediatric outpatient visits for abdominal pain. Computed tomography (CT) and ultrasonography (US) are two imaging modalities used in the diagnostic evaluation of acute pediatric appendicitis. Both have decreased the incidence of negative appendectomy results. It is well known that CT has greater diagnostic accuracy than US for diagnosing acute appendicitis, but there is concern over long-term cancer risk, with routine use of CT in children. What modality should be used for pediatric patients who are suspected of appendicitis? [+]
Patwari Academy video: Early goal directed therapy
Do you know the protocol for early goal directed therapy (EGDT)? It’s all about IV fluids. Get the scoop here in this 12 minute video. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and [+]
Transient Synovitis vs Septic Arthritis of the Hip
Limping is a common reason for parents to bring their children to emergency departments. It is known that 77% of acute, atraumatic limp is dealt with in the ED, and 20% do not even complain of pain.1 Our job as physicians is to complete appropriate assessments to not miss any serious pathology. Specifically, differentiating between transient synovitis (TS) and septic arthritis (SA) of the hip can be difficult and frustrating for everyone. What is your approach? [+]
Trick of the Trade: Urine Collection in Neonates
The Case: A 8-day-old, uncircumcised male is brought to the ED with fever, irritability, and decreased urination. The Problem: Getting a clean catch urine in a timely, non-invasive manner The Solution? [+]
Director of Growth, Strategic [+]
The SCRAP Rule: Indications for chest CT in blunt trauma
At my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 1 looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment. [+]
Trick of the Trade: Making the NG and NP procedures less painful
When doing nasogastric (NG) tubes and fiberoptic nasopharyngoscopy (NP) procedures, there many approaches in how patients can be locally anesthetized. Getting things pushed up your nose is so profoundly irritating that most patients only give you 1 or 2 changes to get it right. One option is to use nebulized lidocaine, although it takes a while to prepare and anecdotally tends to numb mainly the hypopharynx, placing the patient at risk for aspiration later on. Another option is to use viscous lidocaine to coat the NG or NP tubing, but this is fairly messy and only mildly helpful. Commercial intranasal [+]
Patwari Academy video: Altered mental status
Get an organized approach on the broad chief complaint of “Altered Mental Status”. Learn about the AEIOU TIPS mnemonic om this 20 minute video by Dr. Rahul Patwari. [+]
Director of Growth, Strategic Alliance Initiative, Center [+]
Management of Syncope
“Done Fell Out”, or DFO, is a common saying in the South to describe syncope. Although the saying is funny the diagnosis is not. Syncope accounts for about 3–5% of ED visits and 1–6% of hospital admissions. In patients >65, syncope is the 6th most common cause of hospitalization. How do you approach the management of patients with syncope? [+]
Sim Case Series: Perimortem C-Section
Case Writer: Clare Desmond, MD Peer Reviewer and Editor: Nikita Joshi, MD Keywords: Cardiac arrest, Perimortem C-section [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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