What’s the Code Dose of tPA?
Suppose you have a patient in whom you highly suspect a pulmonary embolism (PE) that devolves into PEA arrest while awaiting a CT angiogram. Or, what about a patient with an ECG showing clear STEMI that loses pulses? [+]
Lytics for sub-massive PE: Ready for primetime?
There was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al1, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs. Should we be considering tPA in patients with sub-massive PEs? [+]
Trick of the Trade: Ambient noise and creative cognition
For many of us in academia and medical education, we accomplish a tremendous amount of work outside of the workplace. This can be in our home office, on the public transit system, or in the library. Interestingly, creative cognition occurs best with a moderate amount of ambient noise (not too much and not too little), according to a 2012 article from Journal of Consumer Research. [+]
Need your input! PV cards becoming an app
It’s all about luck, opportunity, and timing. I will be releasing the blog’s first ever Paucis Verbis (PV) native app this year. After a few years of brainstorming and lots of reader inquiries about an app, we were approached by two different app-building companies in the same week. I’m incredibly humbled to be approached by organizations, who can see the potential of these pocket cards (which started as actual index cards while I was in residency). It is an incredibly exciting time to be in the world of education and social media! I need your help with step 1. [+]
Patwari Academy videos: Chest trauma
In the third and fourth video in the Trauma series (first two videos = primary and secondary survey), Dr. Rahul Patwari discusses about chest trauma, divided into blunt and penetrating mechanisms. What is “the box” that everyone keeps referring to? [+]
PE in pregnancy: which diagnostic tests do you use?
Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging. [+]
Trick of the Trade: External jugular tourniquet
Paitents can be a challenge when trying to obtain peripheral IV access. The vein may be collapsed from dehydration or scarred because of IV drug use or repeated cannulation. Before thinking about an ultrasound-guided deep vein IV or a central line, take a look at the external jugular (EJ) vein. There are, however, a few problems that exist when trying to cannulate this site: There is no tourniquet for the neck. To distend the vein, you often need to put the patient in Trendelenburg, which may be uncomfortable or intolerable for some [+]
Patwari Academy videos: Trauma primary and secondary survey
What’s the primary and secondary survey in the assessment of the trauma patient? This is a great review of the methodical approach and insight in the thought processes by Dr. Rahul Patwari. [+]
Director of Growth, Strategic [+]
Trick of the Trade: Use the angiocatheter for central lines
Central lines come packed with a long introducer needle (pink arrow) to feed the guidewire through AND a long angiocatheter (yellow arrow). Most people cannulate the vein by using the syringe and the introducer needle. What’s the angiocatheter for? [+]
PV card: Bell’s Palsy Treatment
Bell's Palsy is an idiopathic unilateral facial nerve paralysis. Since the 2009 Cochrane review1 showing that antivirals added no benefit to corticosteroids in Bell's Palsy, I stopped prescribing them. The NNT.com site has concluded the same. Looking at the literature a little more, the recommendations are a little murkier. Some groups are still advocating for antivirals for severe cases, because there may be a very small but questionably positive benefit. "Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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