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A 31 year old male was brought to the local trauma center by EMS after being found in full arrest with stab wounds to the bilateral lower extremities and a significant amount of blood at the scene but no other obvious injuries. In the field he was pulseless and apneic, initial rhythm was an agonal PEA with […]
This ECG demonstrates LBBB, Atrial Fibrillation with RVR, and Aberrancy. The patient presented hypotensive and confused. He was successfully cardioverted with 200 J after failed initial attempts with 100 J and 150 J.
By Jason Naylor PA-C Doppler ultrasound (DUS) is the study of choice for evaluating testicular torsion. Various studies demonstrated a range of sensitivity from 80 – 98%, while specificity consistently remained between 97 – 100%1-3. DUS findings specific for testicular torsion are twisting of the spermatic cord, no central arterial flow of the affected testis, […]
Procalcitonin: All the rave? Anthony J. Hackett, DO There seems to be an awful lot of talk lately about the utility of procalcitonin in prognosticating, detecting and tracking bacterial infections. This article review looks at a fairly recent meta-analysis in The Lancet Journal of Infectious Disease which aims to look at all of the data […]
A 29-year-old male professional athlete presented to the emergency department complaining of visual changes. He described intermittent loss of vision in the right half of his visual field affecting only the right eye. The onset of the symptoms was approximately five minutes after neck manipulation by his chiropractor. While sitting in the chiropractor’s waiting room […]
By Anthony J. Hackett, DO There are several complications that should be considered when pacemakers go bad: lead failure, pocket complications and device complications. Early post placement complications: pneumothorax, hemothorax and venous thrombosis and air emboli Lead failure: -Dislodgement: More common in ICD (10%) than in pacers (5%) -Fracture: occurs where kinks in wire are […]
Anthony J. Hackett, DO Given the increasing use of pacemakers and AICD’s in medicine, it is not uncommon to encounter these devices in clinical practice. Familiarity with common errors is paramount especially given their approximately 6% per year chance of malfunction. This brief review serves to help make sense of the letters, numbers and symptoms […]
Posted is a very informative review article discussing the role of corticosteroids in cardiac arrest and the post arrest period. The review is open access and is attached here. It is an informative discussion of the physiology behind the corticosteroid depletion related to arrest as well as the role of corticosteroids as inotropes and pressor […]
By Joel A. Miller, MD, FAAEM, FACEP Recently, we reviewed a landmark study published in the New England Journal of Medicine (NEJM Missed diagnosis of ACS in the ED_2000) that formed much of the foundation and justification of the AHA guidelines that currently guide our practice in caring for patients with chest pain. In looking […]