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 [+]
Calcium before Diltiazem may reduce hypotension in rapid atrial dysrhythmias
The Case A 56 y/o man presents to the ED via ambulance. He was sent from clinic for ‘new onset afib.’ His pulse ranges between 130 and 175 bpm, while his blood pressure is holding steady at 106/58 mm Hg. He has a past medical history significant for hypertension and hypercholesterolemia. His only medications are hydrochlorothiazide and atorvastatin. The decision is made to administer an IV medication to ‘rate control’ the patient with a goal heart rate < 100 bpm. Calcium channel blockers, such as diltiazem and verapamil, can both cause hypotension. In the case above, the patient has [+]
How Social Media is Making an Impact in Medicine
Whether you realize it or not, the use of social media (i.e. Facebook, twitter, and blogs) has found its way into the world of medical students, residents, physicians, and medical educators all around the world. The use of these resources has several advantages versus in-person/print educational tool: Overcomes physical or temporal barriers Provides searchable content Encourages interactivity [+]
Review: Emergency Medicine: Avoiding The Pitfalls and Improving The Outcomes
A pitfall is defined as “an unapparent source of trouble or danger; a hidden hazard” by thefreedictionary.com. In the book Emergency Medicine: Avoiding the Pitafalls and Improving the Outcomes edited by Dr. Amal Mattu along with Dr. Deepi Goyal, you can find many pitfalls that should be considered when managing patients in the emergency department. The book, relatively affordable ($57) when it comes to print hard-bound textbooks, consists of 13 quick-read chapters of common chief complaints in emergency medicine. Some of the authors in this book include: Drs. Peter DeBlieux, Jairo Quintanilla, Robert Rogers, Michael Winters, and others. [+]
Patwari Academy video: Discharge instructions
Read more about the writing of appropriate ED discharge instructions. Clear communication of your thoughts and recommendations are a crucial part of patient care despite their no longer being in the ED. Learn about the pearls and pitfalls in writing instructions in this short 7.5 minute video. 1 [+]
SAEM/CORD slides: Social Media for Emergency Educators
As requested by an audience member at today’s talk at SAEM, Drs. Rob Cooney, Mike Bond, and I are sharing our slides and handout on Social Media for Emergency Medicine Educators with you here. [+]
Director [+]
ALiEM Sim Case Series: Pediatric WPW
Case Writer: Nikita Joshi, MD Keywords Pediatrics, Syncope, Wolff Parkinson White (WPW), PALS Educational Objectives Medical Discuss a broad differential diagnosis for pediatric syncopeIdentify critical findings in pediatric EKGManage WPW tachycardia Communication Obtain a focused history in a pt with WPW focusing upon family historyCommunicate as an interdisciplinary team Case Synopsis 10 yo boy BIBEMS s/p syncope. Pt was playing on the football field, running down field when he suddenly collapsed. Bystanders quickly went to the boy and within 1 minute the pt had regained consciousness without any intervention. When EMS arrived on the scene, the boy was sitting with [+]
PV card: Early repolarization vs STEMI on ECG
You are handed an ECG for a 50 year old man with moderate chest pain for 2 hours now and no associated symptoms typical for ACS, PE, aortic dissection, or any other red flags of chest pain. He has no prior ECG's on file. Is this early repolarization or ST elevation MI? Should I activate the cardiac catheterization lab? Image courtesy of Dr. Steve Smith at HQMedEd-ecg.blogspot.com Here are some great literature-based pearls compiled by Dr. Jason West (@JWestEM), an EM resident from Jacobi/Montefiore. PV Card: ECG - Early Repolarization vs ST Elevation MI Adapted from [1–7] Go to [+]
Three predictors for success in cardiac arrest resuscitations
The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes. Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with good patient outcomes. [+]
Improving Consultation Communication Skills
Talking to colleagues is an essential skill especially as we advocate for our patients. We should not only know what’s going on with our patients, but also how to communicate our thoughts effectively and succinctly with our colleagues. In a great article by Dr. Chad Kessler et al 1 just published Academic Medicine, the authors state that although “communication skills may not develop naturally, [they] can be taught and fostered through evidence-based educational models.” [+]