To the Class of 2016 – Congratulations!! You’ve made it. After at least 11 years of post-high school education, you have finally reached that proverbial finish line and are ready to transition from resident to attending. What I would like to share with you is some advice about what life is like on the other side. Now that you have finished residency, it’s safe to say that you know the medicine really well. But, I have come to find that your learning about life as a professional is just beginning.
Who are the people you consider the biggest leaders and influencers of change in our profession? What traits do they have that seem to make them a natural for their role? How did they get there? Perhaps even better questions to ask – what makes some people more engaged in their job? Why do some people bounce back from the stress of our jobs better than others do? Are there common traits that overlap leadership and resilience?
The young female with lower abdominal pain. The middle-aged male with atypical chest pain. The elderly female that presents with vague symptoms of dizziness. These are just the tip of the iceberg of chief complaints we will see in our emergency medicine careers. Those with symptoms that don’t fit into a particular diagnostic box or with totally clean workups can be frustrating for patients and physicians alike. We are taught in medical school that 90% of diagnoses can be made with a very meticulous history and physical. But, until I was asked to write on the topic of diagnostic uncertainty, I had never really thought about how infrequently we actually make a slam dunk, no doubt about it diagnosis.
When it comes to ACS, some ECGs are obvious. This article is not about those ECGs. This article will be the first in a series of blog posts related to subtle ECG findings in ACS. In this post we will look at ECG findings associated with left main coronary artery disease and explore the significance of ST-segment elevation in the “forgotten lead”.
- Feb 4th, 2016
- Justin Bright
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An 82 year-old man with a history of dyslipidemia, hypertension, and CAD s/p stenting was driving home from the grocery store when he experienced sudden vision loss in his right eye around 2:30 pm. He has no previous history of vision problems and is puzzled but eventually concerned. By the time he presents to the ED he has light perception only in his right eye. He cannot not recognize motion. Central retinal artery occlusion (CRAO) is first in the differential.
Endophthalmitis is a rare, but clinically significant infection. It is often misdiagnosed due to the multitude of other ocular diseases that share similar presenting symptoms. It results from an infectious or non-infectious inflammatory process of the vitreous and aqueous humors. Missed or late diagnoses can have severe consequences, including permanent vision loss. The natural history of the disease thus necessitates a high degree of clinical suspicion in all patients, especially those at increased risk.
24-year-old male presents via EMS after being involved in altercation. According to bystanders, patient was noted to sustain several gunshot wounds from close range, notably to the left anterior chest and left upper extremity. On EMS arrival, patient was diaphoretic but awake, with GCS of 15, heart rate 140 bpm, blood pressure 95/60 mmHg, respiratory rate 26 with room air oxygen saturation of 90%. On arrival in the ED, patient becomes initially combative, then develops altered mental status. Examination now reveals no palpable pulses or measurable blood pressure.
- Dec 8th, 2015
- Justin Bright
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A 62 year-old male presents to the emergency department (ED) with low back pain after a mechanical fall as he slipped on a puddle of water. After a 14 hour wait, he finally gets moved to an exam room. Upon examination you notice lumbar spine tenderness with inability to flex his left thigh. A CT of his lumbar spine demonstrates a L2 vertebral body fracture with retropulsion. The patient has to be transferred to another hospital due to unavailability of neurosurgical services. Delays in care were mostly due to boarding patients and lack of staff.