Contributor: Travis Barlock, MD Educational Pearls: The presence of a STEMI has traditionally been used to determine if a patient with acute chest pain requires urgent cath lab management STEMI indicates an occluded coronary artery, and urgent intervention is needed to restore perfusion to ischemic tissue Patients with occluded coronary arteries can present with EKG…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: In urban settings, it is becoming more common for police to transport critical patients from scene to hospital A 2022 multicenter observational study compared mortality rates in patients with penetrating injury to torso and/or proximal extremity when transported by EMS versus police Approximately 18% of patients were transported by…
Read MoreContributor: Travis Barlock, MD Educational Pearls: Catheter related blood infections were thought to be caused by skin flora seeding the catheter. Thus, significant effort is applied to sterility and skin preparation. However, studies have shown that bacteria growing on the tip of the catheter is not consistent with growth on cultures of skin. Staphylococcus epidermidis…
Read MoreContributor: Jared Scott, MD Educational Pearls: Immediate resuscitative thoracotomy can be performed in the ED to gain rapid access to the thoracic cavity in cases of traumatic cardiac arrest Western Trauma Association Society Criteria for ED thoracotomy Blunt trauma + <10 min of prehospital CPR Penetrating trauma to torso + <15 min prehospital CPR Penetrating…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Lateral Cutaneous Femoral Nerve Entrapment Syndrome, also known as Meralgia Paresthetica, results from entrapment of the lateral cutaneous femoral nerve, often as it exits the pelvis under the inguinal ligament. Meralgia Paresthetica is associated with obesity, pregnancy, compression from clothing or belts and diabetes. Symptoms include numbness, paresthesia and…
Read MoreContributor: Travis Barlock, MD Educational Pearls: An EKG should be obtained quickly after a syncopal event to identify possible life-threatening causes such as ischemia and arrhythmia WOBBLER is a good mnemonic for remembering additional EKG findings to look for in syncope Wolff-Parkinson-White (WPW) Check for delta wave on QRS Obstructed AV node Any potential heart…
Read MoreContributor: Don Stader, MD Educational Pearls: Home naloxone is traditionally given to those at high risk for opioid overdose such as those in the ED due to an opioid overdose, opioid intoxication, or admit to illicit opioid use There are a number of other patient populations that benefit from home naloxone including those on chronic…
Read MoreContributor: Jared Scott, MD Educational Pearls: Elevated lactate levels can be a useful indicator of critical illness in patients who meet SIRS criteria Lactate can also be elevated due to other causes including seizures and medications such as albuterol and metformin A recent study from Switzerland* performed routine point-of-care lactate testing in all elderly patients…
Read MoreContributor: Don Stader, MD Educational Pearls: There are two major groups of local anesthetics: Amide and Esther To recall what group an anesthetic belongs to, use this memory trick: Amide has an ‘i’ in the name and Amide anesthetics have 2 ‘i’s e.g., Lidocaine. Ester has no ‘i’ and most common Ester anesthetics have only…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: 2020 retrospective study with dat from two California hospitals compared rates of cardiovascular admissions in a five day period two weeks before and the five days after the presidential election Hospitalization rate for acute cardiovascular disease increased by 17% and rate of acute myocardial infarction increased by 42% Highest…
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