Author: Jared Scott, MD Educational Pearls: Differentiating symptomatic bradycardia from asymptomatic may be essential in determining workup and treatment Airway, breath, circulation always hold true Symptoms may include dizziness, syncope, or weakness An EKG is essential in the majority of cases Complete heart block can be a cause of symptomatic bradycardia and requires immediate attention…
Read MoreAuthor: Aaron Lessen, MD Educational Pearls: New data shows within 5 years of smoking cessation, the risk of cardiovascular disease becomes half of those who continue to smoke After 10-15 years of cessation, cardiovascular disease rates return to rates seen in non-smokers. Lung disease, COPD, and cancer rates do not decrease quite as rapidly, but…
Read MoreAuthor: Nick Tsipis, MD Educational Pearls: Aortic injury caused by blunt trauma is very rare Chest x-ray findings might include widening of the mediastinum Ligamentum arteriosum (remnant of the ductus arteriosus) tethers the aorta to the chest wall, potentially causing injury with abrupt decelerations and motion XR lacks significant sensitivity (around 75%) to be utilized…
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Completely disassociated Chief Complaint: Syncope HPI: An 82-year-old male with a history of bradycardia, HTN and HLD arrives in the emergency department via EMS with altered mental status, pacer pads in place active pacing going. Patient is primarily Russian-speaking and his wife is assisting with translation. The patient is not able to correctly answer what…
Read MoreContributor: Don Stader, MD Educational Pearls: High-quality compressions are an essential, and probably one of the most important, part of cardiac arrest Actual evidence for drugs in cardiac arrest included in ACLS are limited, including epinephrine, bicarbonate, amiodarone, etc. Early defibrillation for ventricular tachycardia (VT) or ventricular fibrillation (VF) has a plethora of supporting evidence…
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Superior Vena cava syndrome Chief Complaint: Facial Swelling HPI: Patient presents to the emergency department reporting several days of recurrent facial swelling. She states that when she wakes in the morning, starting 3 days ago, she has significant facial swelling. Yesterday there was some extension of the swelling down to her bilateral upper extremities and…
Read MoreContributor: Jared Scott, MD Educational Pearls: Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushing, and parasthesias Common causes of SVC syndrome include lung cancer, lymphoma, and thymoma Keep SVC syndrome on the differential for all patients with facial or upper…
Read MoreContributor: Charleen Melton, PharmD Educational Pearls: Desmopressin (DDAVP) is an analogue of anti-diuretic hormone (ADH) that has been used for the treatment of intracranial hemorrhage. It works by increasing the release of Von Willebrand factor, helping to stabilize clots. The use of DDAVP for intracranial hemorrhage in patients on antiplatelet agents (mainly Aspirin and Plavix)…
Read MoreContributor: Sue Chilton, MD Educational Pearls: More intracardiac devices and injection drug abuse are thought to be increasing incidence of endocarditis Classic signs of endocarditis have included: Osler nodes (painful hemorrhagic lesions on hands and feet), Janeway lesions (painless hemorrhagic lesions on the hands and feet), and splinter hemorrhages in the nail beds Other classic…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Peri-arrest patients present a particular challenge to ED providers, as the differential is broad and time is critical The differential for near cardiac arrest includes the “H’s and T’s”, just as in true cardiac arrest The 6 H’s include: hypoxia, hypo/hyperkalemia, hypovolemia (including shock states), hydrogen (acidosis), hypothermia The…
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