Patwari Academy video: Torsades de Pointes
Torsades de pointes is a polymorphic form of ventricular tachycardia. Why does this occur? What does it characteristically look like? Why is this an important form of ventricular tachycardia to differentiate from the more classic monomorphic ventricular tachycardia? View this short 9 minute video on QT intervals and Torsades de Pointes. [+]
Lead aVR: The Forgotten 12th Lead
Augmented leads (aVR, aVF, and aVL) were developed to derive more localized information looking at the right, lower, and left part of the heart respectively. Specifically, lead aVR obtains information from the right upper side of the heart. It also gives reciprocal information on the left lateral side of the heart, which is already covered by leads aVL, I, II, V5, and V6. This is the main reason lead aVR has become forgotten. [+]
Wellens’ Syndrome: Is it on your radar?
Wellen’s Syndrome was first described in 1982 in which 75% of patients with t wave inversions in V2-V4 went on to have an acute myocardial infarction (MI). This was again repeated in 1989, and showed that all patients with this morphology had >50% LAD stenosis. The incidence in the United States is about 10-15%. [+]
Must We Avoid Nitrofurantoin with Impaired Renal Function?
Acute uncomplicated cystitis is becoming more difficult to treat in the setting of increasing antimicrobial resistance. In the 2010 IDSA Guideline, as summarized in a PV Card on Cystitis and Pyelonephritis in Women, nitrofurantoin is now listed as the first-line choice, surpassing ciprofloxacin and sulfamethoxazole/trimethoprim from the previous iteration. [+]
RUSH protocol: Rapid Ultrasound for Shock and Hypotension
Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for the evaluation of critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states. The RUSH Protocol was first introduced in 2006 by Weingart SD et al, and later published in 2009. It was designed to be a rapid and easy to perform US protocol (<2 minutes) [+]
PV card: Pediatric Assessment Triangle
Have you heard of the Pediatric Assessment Triangle? Taught in the Pediatric Education for Prehospital Professionals (PEPP) certification course, it provides a clear and simple approach to the emergency assessment of pediatric patients. The following PV card summarizes the PAT: PV Card: Pediatric Assessment Triangle Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Dieckmann R, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26(4):312-315. [PubMed]
Out-of-Hospital Cardiac Arrest and Prehospital Intubation
Worldwide, death from cardiac arrest in the out-of-hospital setting remains the leading cause of mortality. Focuses have aimed at improving bystander CPR, public access to AEDs, minimizing chest compression interruptions, and decreasing the emphasis on advanced airway management. This latter concept has become so important that the AHA/ASA have now changed their “ABC” philosophy to “CAB.” Below is the review of the literature that has changed this philosophy. [+]
Patwari Academy video: Child abuse injury patterns
What are common injury patterns seen in children who are abused? Non-accidental trauma should always be considered in pediatric patients who present with traumatic injuries. Watch this great 8 minute video on child abuse injury patterns by Dr. Rahul Patwari. [+]
On the Horizon: Propofol for Migraines
Propofol for the treatment of migraines in the ED might be on the horizon. This will possibly be a new practice in emergency medicine, although it has been known for some time. Propofol, when given at procedural sedation doses, seems to miraculously terminate migraines refractory to usual treatment. Patients awake with minimal to no headache and may be discharged from the ED much quicker than traditional treatment with possibly less side effects. The proposed mechanism of action is described in below papers, but in short, propofol seems to “reboot” the brain and terminate the migraine. [+]
PV Card: Contraindications to Thrombolytics in Stroke
This Paucis Verbis (PV) card is an updated version of the PV card on Contraindications to Thrombolytics for CVA from September 10, 2010, based on the Stroke 2013 AHA/ASA new guidelines that were just published.1 Some changes include... There is new mention of new anticoagulants in the market with additional absolute exclusion criteria. A blood glucose < 50 mg/dL has been upgraded from a relative exclusion to an absolute exclusion criteria. There is no more mention of glucose > 400 mg/dL as an exclusion criteria. Seizure at onset of presentation has moved from an absolute to a relative risk. Post-AMI pericarditis is no longer [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Latest posts by Shuhan He, MD (see all)
- The Discharge Severity Index: Early Research on ED Readmission Risk Assessment - August 14, 2025
- Suboxone and the Emergency Physician: Get Waivered Training - August 12, 2022
- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis - April 23, 2020