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.” [+]
Patwari Academy videos: Salter Harris fractures
Dr. Rahul Patwari discusses Salter Harris fractures in pediatric patients with a helpful mnemonic to help you remember the categories. He also poses several questions in the first video, which are answered in the second video. [+]
Deception and Simulation
Have you ever created a simulation case with hidden objectives that the learners were not aware of? Would you ever purposefully try to trick or deceive learners in a simulation case? Simulation can be used to reinforce clinical and procedural knowledge. It can teach important teamwork skills. It can also be used to learn about ourselves in morally and ethically challenging situations. [+]
PV card: Ectopic pregnancy
Ectopic pregnancy is the leading cause of maternal death in the first trimester of pregnancy. A recent JAMA systematic review,1 from The Rational Clinical Examination series, looked to risk-stratify women in early pregnancy presenting with abdominal pain or vaginal bleeding for ectopic pregnancy. The authors set out to identify the accuracy and precision of elements in the history, physical examination, beta hCG, and ultrasound in ectopic pregnancy. The systematic review consisted of 14 studies (n=12,101). The search consisted only of English language studies from 1965 to 2012 in which ectopic pregnancy was the final diagnosis with 100 or more patients per article. The [+]
Pediatric Appendicitis: CT or Ultrasound?
Appendicitis is the most common pediatric surgical emergency accounting for 5% of urgent pediatric outpatient visits for abdominal pain. Computed tomography (CT) and ultrasonography (US) are two imaging modalities used in the diagnostic evaluation of acute pediatric appendicitis. Both have decreased the incidence of negative appendectomy results. It is well known that CT has greater diagnostic accuracy than US for diagnosing acute appendicitis, but there is concern over long-term cancer risk, with routine use of CT in children. What modality should be used for pediatric patients who are suspected of appendicitis? [+]
App Review: EMRA Basics of Emergency Medicine
The app EMRA Basics of Emergency Medicine covers the 20 most common EM complaints in a concise manner. I first heard about it from Dr. Rob Orman’s (@emergencypdx) podcast (ERCast) where he endorsed it when it was only in book format. The book is great, thin, and it fits in a white coat pocket. Here is an in-depth review of the app. [+]
Patwari Academy video: Early goal directed therapy
Do you know the protocol for early goal directed therapy (EGDT)? It’s all about IV fluids. Get the scoop here in this 12 minute video. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital [+]
Death and Simulation
Should the manikin ever die in a simulation scenario? Effective simulations require suspension of disbelief and willingness by learners to play along with the game created by the facilitators. Without this buy-in, learners could argue against discrepancies, simply on the basis that the scenario is not real. Learners give their trust that the educators will also play the same game, and that the rules will not change. [+]