Chest Pain: Coronary CT Angiography in the ED
It is well known that taking a good history and physical, getting a non-ischemic EKG, and serial cardiac biomarkers, results in a risk of death/AMI of <5% in 30 days. Patients, in whom you still suspect have CAD, should undergo provocative testing within the next 72 hours based on the AHA/ACC guidelines. Their guidelines deem provocative testing as including: Exercise treadmill stress test, Myocardial perfusion scan, Stress echocardiography, and/or Coronary CT angiography (CCTA). [+]
Trick of the Trade: Fluorescein for lost contact lens
A patient’s contact lens broke when she was trying to take it off. She feels the pieces are still inside her eye, but she was unable to fish them out. When you look through the slit lamp, you are unable to to see whether there are contact lens pieces inside since they are clear. [+]
NG Lavage: Indicated or Outdated?
Nasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence support the logic? Most studies state that endoscopy should occur within 24 hours of presentation, but the optimal timing within the first 24 hours is unclear. Rebleeding is the greatest predictor of mortality, and these patients benefit from aggressive, early endoscopic hemostatic therapy and/or surgery. So what are the arguments for and against NGL? [+]
10 Tips to Success as a Junior Faculty in Academic Medicine
As I am getting into my 3rd year of practice as a faculty in Emergency Medicine and Internal Medicine, I have begun to wish I had a better framework for success in academic medicine. Currently, almost on a daily basis, I have to answer about 100 emails, decide if I want to be on different committees, develop curricula, give lectures, do research, work clinically, mentor residents/medical students, and have a work-life balance. Does this sound familiar, and at the same time overwhelming? Recently I read several articles on this very topic and thought maybe I would give some perspective on [+]
Writing content for social media? Protect yourself!
In the past few months, this blog has been successful in working with Google to remove pirating sites, which directly cut and paste all of our content (including PV cards!) directly into their own blog as their own. This broaches the greater question of disclaimers, copyright, and privacy. Last month, Dr. Steve Carroll (EM Basic) nicely summarized these issues and constructed nice language for anyone’s social media productions. In fact, with his permission, I have incorporated much of the wordings into this blog’s disclaimer section (bottom of About Us). [+]
Be a great speaker: 10 practical pearls (part 4 of 5)
For the CORD Distinguished Educator’s Coaching Program, Dr. Gus Garmel has kindly offered to share his top 50 points to improve one’s speaking skills. These tips are great for anyone who plans to do public speaking. Thus far, this “be a great speaker” series has reviewed 30 pearls. [+]
Are IVs scut work?
Is there educational value to teaching and learning how to place peripheral IVs? Not the exciting central lines, IOs, or ultrasound guided IVs. I am talking about straight forward and routine peripheral IVs. Or is this scut work? Can there be any educational value to scut work? [+]
Chest Pain: Can we do 2-hour rule outs?
Hospital admissions for chest pain often incur costly and resource-intensive workups for ACS. Is there a way to identify a low risk group who can be discharged home in a timely manner, without further workup, and without short-term adverse events from ACS? [+]
Rivaroxaban for Pulmonary Embolism: One pill and done?
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?
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 [+]