Contributor: Nick Hatch, MD Educational Pearls: Complete heart block or 3rd degree atrioventricular (AV) block is diagnosed via EKG and occurs when electrical signals from the sinoatrial (SA) node are blocked from reaching the ventricles via the AV node and AV bundles P waves and QRS complexes are independent Often QRS rate is around 40…
Read MoreContributor: Nick Tsipis, MD Educational Pearls: Humerus fractures can be characterized as proximal, midshaft, and distal fractures Proximal humerus fracture is the second-most common fracture in elderly patients Primary complication is with the axillary nerve and axillary artery Vast majority are managed nonoperatively with a sling, reduction usually not indicated Women comprise 70% of proximal…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Pelvis is comprised of the iliac, ischium, and sacrum Three mechanisms for pelvic fractures by Young-Burgess Classification Anterior-posterior compression causing open-book pelvic fractures that can be complicated by retroperitoneal bleeding or urethral injury Lateral compression causing rami fractures Vertical sheer causing offset of sacroiliac joint or sacrum Mechanically stable…
Read MoreContributor: Ricky Dhaliwal, MD Educational Pearls: CRASH 3 Trial looked at over 12,000 patients with traumatic intracranial bleeds, randomizing patients to a therapy with TXA or standard of care without TXA Dosing was 1 gram over 10 min for loading dose and then an infusion of 1 gram over 8 hours Found Improvement in survival…
Read MoreContributor: Chris Holmes, MD Educational Pearls: In the 1700s, boxes lined the River Thames to pump smoke up the rectum to resuscitate people who had been found unconscious in the river Sea cucumbers can extract oxygen through their rectum Perflourocarbon, a liquid that can become oxygenated, provided rectally was able to oxygenate pigs and mice…
Read MoreContributor: Ricky Dhaliwal, MD Educational Pearls: Hypotension in patients requiring intubation should be resuscitated as much as possible While intubating, the negative inspiratory pressure goes away decreasing cardiac preload and worsening hypotension Phenylephrine can be given via push doses to increase blood pressure from alpha agonism For sedation, avoid propofol with hypotension and opt for…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: DEVT Trial, a recent non-inferiority study, looked at giving tPA prior to endovascular thrombectomy and was stopped early because there was no benefit shown to giving tPA before this intervention Coupled with the SKIP and DIRECT MT trials corroborating these findings, it appears that giving tPA prior to thrombectomy…
Read MoreContributor: Jared Scott, MD Educational Pearls: PID (pelvic inflammatory disease) occurs when the infection ascends into the uterus Tubo-ovarian abscess occurs when the infection ascends to the fallopian tubes Fitz-Hugh-Curtis syndrome occurs when the infection enters the peritoneum and causes peritoneal inflammation with peri-hepatic inflammation These conditions require GYN consultation and often more robust antibiotic…
Read MoreContributor: Jared Scott, MD Educational Pearls: Recent study evaluated vaginal self swab testing for STIs to determine if they are equally sensitive to provider-obtained swab 515 patients consented to both tests and 95% agreement was found between the two methods of obtaining samples 75% of participants who preferred this over the pelvic exam, although some…
Read MoreContributor: Dr. Nick Gorton, MD Educational Pearls: Use transgender people’s correct names and pronouns, the Russell study found a 56% reduction in suicide behavior with chosen name usage ⅕ to ½ of transgender people report they avoided seeking care in the ED because of fear of transphobic treatment Understanding the definitions of gender identity, gender…
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