Acute Pulmonary Embolism: Size does matter and ECG can give us clues

By |Categories: Cardiovascular, ECG, Pulmonary|

Acute pulmonary embolism (PE)  is a common condition that can be both severe and difficult to diagnose. Half of all acute PE cases are diagnosed in the emergency department, and acute PE follows acute coronary syndrome as the second most common cause of sudden unexpected death in outpatients. Also, right ventricular dysfunction is a consequence of massive/submassive acute pulmonary embolism and correlates with a poor prognosis and high mortality rate. Although an ECG lacks both sensitivity and specificity for acute PE, there are some clues that can help in determining the size of an acute PE. […]

Diagnosing hyperthyroidism: Answers to 7 common questions

By |Categories: Endocrine-Metabolic, Expert Peer Reviewed (Clinical)|

The prevalence of hyperthyroidism in the general population is about 1-2%, and is ten times more likely in women than men. The spectrum of hyperthyroidism ranges from asymptomatic or subclinical disease to thyroid storm. So how do we diagnose various presentations of hyperthyroidism in the Emergency Department? Below are answers to 7 common questions that commonly arise. […]

Patwari Academy videos: Evidence Based Medicine (part 2)

By |Categories: Patwari Videos|Tags: |

In part 2 of this Evidence Based Medicine series by Dr. Rahul Patwari, more advanced statistical concepts are reviewed. These concepts include ROC curves, screening tests, probability (multiplication and addition rules) and the binomial theorem. Sounds daunting but these short videos really condenses the concepts into digestible lessons. […]

Free Study Guide for EMS Board Exam

By |Categories: EMS, Medical Education|

The faculty and fellows of the UCSF EMS/Disaster Fellowship Program met monthly over the past 2 years to to write a study guide for for the EMS Medical Board exam based on the National Association of EMS Physician’s (NAEMSP) seminal textbook Emergency Medical Services: Clinical Practice and Systems Oversight [Amazon link] (Kendall Hunt Publishers, David C Cone, Robert E O’Connor and Raymond L Fowler, Series Editors, 2009). We condensed approximately 1,800 pages into 69 pages with a simple format: summary of material and take home messages to help improve our EMS system. […]

The Ultimate Consult Service: Emergency Pharmacists

By |Categories: Tox & Medications|

Imagine a consult service located IN the ED. The consultants are some of the friendliest people you’ve met and are there to help you. They tirelessly go out of their way to guide you through hospital protocols, help you with treatments, keep a close eye on your work, and ensure that you and your patients stay out of trouble. Not only are these consultants helpful to you, but also your residents, mid-levels, nurses, and the admitting teams. Everything they know, they teach you – and some are very active in FOAMed and emergency medicine research. […]

September 2013 Update: Expert Peer Reviewed posts

By |Categories: Expert Peer Reviewed (Clinical)|

It’s been a month since we started adding expert peer reviews to our blog posts, and we have had a flurry of engaging conversation surrounding the new process. During this time we have worked to develop a sustainable peer review process. In fact there are two ongoing expert peer-review processes: Clinical articles:  There have been 10 clinical articles thus far expert peer reviewed on a post-publication basis. See list below. MEdIC series: Dr. Teresa Chan and Dr. Brent Thoma host this monthly series on challenging educational cases with initial posited questions, followed by a summary review which includes expert input (added [...]

10 Tips for Approaching Abdominal Pain in the Elderly

By |Categories: Expert Peer Reviewed (Clinical), Geriatrics|

After seeing your fifth young patient of the day with chronic pelvic pain, constipation, and irritable bowel syndrome, it is easy to be lulled into the mindset that abdominal pain is nothing to worry about. Not so with the elderly. These 10 tips will help focus your approach to atraumatic abdominal pain in older adults and explain why presentations are frequently subtle and diagnoses challenging. […]

Patwari Academy videos: Evidence Based Medicine (part 1)

By |Categories: Patwari Videos|Tags: |

Across the medical profession, an essential skill is to be able to understand and interpret original research publications to guide your evidence-based practices. Dr. Rahul Patwari reviews the basics of statistics, specifically sensitivity and specificity, predictive values, probability, and the tradeoff between sensitivity and specificity. […]

Trick of the Trade: EMLA for Lumbar Punctures

By |Categories: Tricks of the Trade|Tags: |

A 9 year-old patient presents with a headache and fever after swimming, along with subjective neck stiffness. Meningitis was of concern especially because the serum WBC count was 25,000 and other inflammatory markers were elevated. Because the patient’s mother had an unpleasant experience with an epidural during childbirth, she adamantly opposed the idea of a lumbar puncture (LP).  […]

Patwari Academy videos: LVADs

By |Categories: Cardiovascular, Patwari Videos|Tags: |

Complications from left ventricular assist devices (LVAD) increasingly account for Emergency Department visits. What are LVADs? They are a short-term, artificial, circulatory device which performs the function of a very poorly functioning heart. It is important to understand the myriad of complications that can arise and the general approach to patients with an LVAD. These two short videos by Dr. Rahul Patwari summarize these in a nutshell. […]