Contributor: Jarod Scott, MD Educational Pearls: Physicians are typically advised not to trust computer interpretation of ECGs Retrospective study was done of computer interpreted normal ECGs to evaluate the accuracy of such an interpretation 989 ECGs were interpreted as “Normal sinus rhythm, Normal ECG” by proprietary cardiology software on MUSE Cardiology Information System These EKGs…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Patients with recurrent ascites may need frequent outpatient or emergency department paracentesis which can be time consuming and uncomfortable for patients. Tunneled peritoneal catheters are a permanent alternative therapy which allows fluid drainage at home by patient or caregiver. There has been theoretical concern that long term placement of…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Tachycardia describes a heart rate of >120 beats per minute Wide Complex describes a QRS duration of >120 ms or 3 small boxes on a standard EKG The major differential for a wide complex tachycardia is Ventricular Tachycardia (VT), aka “V Tach”, or Supraventricular Tachycardia (SVT) with Aberrancy SVT…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications Patients who suffer from this effect are at high risk of developing severe PTSD, depression, and suicidal ideations Occurs in approximately 0.1-0.2% of patients undergoing general anesthesia in an OR setting 2021 study showed…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Intranasal medication administration is a convenient, quick, and relatively painless option for pediatric patients Often used as an initial medication to help control pain in children prior to establishing an IV Using an atomizer is preferred when administering intranasal medications The syringe should be angled towards the ipsilateral eye…
Read MoreIn this second episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: There are two common options for push-dose vasopressor: phenylephrine and epinephrine. Both have been studied in the setting of the OR, but are lacking data in emergency room utilization. A recent retrospective study at one hospital compared the two options for effectiveness and safety. The data showed phenylephrine raised…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: A recent study evaluated the association between the degree of fever and mortality rate in patients presenting to a set of Emergency Departments in Israel Febrile patients with a temperature > 38.0 C were recorded and these patients were compared against local death records to determine the all-cause 30-day…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Patients in renal failure may have elevated serum potassium levels which can result in EKG changes. EKG changes in the setting of hyperkalemia generally depend on the serum level. Mild elevation may cause peaked T waves. At higher serum levels there will be loss of P waves plus wide…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Multiple factors affect if a digit can be reattached including: location of digit injury, mechanism of injury, duration since injury, preservation mechanism. Recommended preservation is via indirect cooling. This is accomplished by wrapping the amputated digit piece in saline soaked gauze, placing the wrapped piece in a waterproof bag…
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