Rivaroxaban for Pulmonary Embolism: One pill and done?

By |Categories: Cardiovascular, Pulmonary, Tox & Medications|

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 […]

Is ATLS wrong about palpable blood pressure estimates?

By |Categories: Trauma|

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 […]

  • Chest Pain Check List

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

By |Categories: Cardiovascular|

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. […]

Mythbuster: No Maximum Dose of Enoxaparin

By |Categories: Tox & Medications|

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? […]

  • Pelvic Speculum

Trick of the Trade: No pelvic bed? No problem

By |Categories: Ob/Gyn, Tricks of the Trade|

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. […]

Ketofol: Is this the “Game Changer” of Procedural Sedation and Analgesia?

By |Categories: Tox & Medications|

When talking about procedural sedation and analgesia, our goal is to minimize pain and anxiety, with the appropriate agent that matches the needs of our patient and the clinical scenario. So what are some qualities of this “ideal agent?” In a perfect world, it would have: Minimal adverse effects Rapid onset and offset of action Pharmocokinetic predictability across a spectrum of patients […]

First ALiEM journal article: Trial of void for acute urinary retention

By |Categories: Genitourinary|

A patient may present to the ED after foley catheter placement for acute urinary retention (AUR) a few days ago and now requests catheter removal. Ideally this should be performed in the urologist’s office. However, occasionally patients cannot or do not follow up with the urologist in a timely manner and return to the ED expecting urethral catheter removal. A careful history and physical should be performed along with a consulting urologist. If the eventual decision is to remove the urethral catheter in the ED, what is important to know about a Trial of Void (TOV)? […]

  • stethoscope

Is it time to trash the stethoscope? The age of ultrasound

By |Categories: Medical Education, Ultrasound|

Is the physical exam a relic of the past, because our tools are relics of a prior era? It is important to do and teach a thorough physical exam. I cautioned against the overreliance on diagnostic testing in lieu of a physical exam, which can be initially burdensome and prolonged. But perhaps our difficulty with the physical exam is not the exam itself, but the tools that we have at our disposal to perform an exam, rather than the exam itself. […]