recent articles

intern report

Post LP Headache

On my first month in the Parkland ED, I saw multiple patients with post-lumbar puncture headaches and even iatrogenically caused one myself.  Often I found myself wondering what proven preventative measures during an LP decrease the incidence of such headaches, what could I have done better, and what literature supports treatment of post-lumbar puncture headaches in the emergency department. [...]

clinical cases

Chief Complaint: "Seizures"

Chief Complaint: “Seizures” History of Present Illness: 25-year-old male with no PMHx, BIBEMS after he had episode of tonic-clonic seizure. As per wife, who gave medical history, the patient was found down in a hotel with "his whole body shaking."  Upon EMS arrival, he was given 5mg of Valium. On arrival to the ED, patient combative, not following commands with frothy oral secretions.  Wife endorses that patient has had weakness, dizziness, and malaise x 3 days, but no other complaints. Patient had another seizure while in the ER without regaining full consciousness. [...]

intern report

Management and Dispo of Upper GI Bleed

Upper GI bleed (UGIB) is a common cause of presentation in the ED with an incidence of 102 per 100,000 hospitalizations. Mortality can range from 2-15%, with a rebleeding risk of up to 10-30%. It is important to identify high-risk patients that are candidates for early endoscopy or if monitored management is more appropriate. Low-risk patients may be identified and safely discharged from the ED. [...]

practice updates

ICP Management Update

Author: Albert Arslan, MD and Anthony Scoccimarro, MD (Resident Physicians, Lincoln Emergency Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital)   Prevent and Identify – the ED’s equivalent of Search & Rescue when managing elevated Intracranial Pressures (ICP). The causes of elevated ICP are typically described in the context […]

intern report

Tranexamic Acid in the ED

A quick case: A 57 y/o F with a PMH of DM, HTN, and Afib on warfarin presents to the emergency department (ED) complaining of spitting out a blood clot when she woke up in the morning. Upon waking she felt something in her mouth, spit out a small blood clot, and continued to have slow oral bleeding over the next several hours leading to presentation in the ED. She is not able to see where the blood is coming from, denies any other symptoms and states her last INR was 2.3. All other ROS is negative. On physical exam, it is noted that the patient has a broken upper left molar that is slowly bleeding. All other physical exam and vitals were normal. The attending physician suggested using tranexamic acid (TXA) for treatment. But what’s that? I didn’t learn about that in med school. Clinical Question: What studied uses are there for tranexamic acid in the Emergency Department? [...]

practice updates

Capnography in the ED

Continuous quantitative waveform capnography, also known as end-tidal carbon dioxide, PetCO2, or ETCO2, is a measurement of the partial pressure of CO2 in the exhaled breath. This technology has been around since the mid-19th century and only relatively recently has its potential in emergency medicine begun to be explored. [...]

intern report

How to Crush ABGs

Stepwise Approach w/ interpretations found below. You won’t need to look anywhere else unless you want to do the Stewart Acid Base Approach. [...]

intern report

tPA

While working on the Neurocritical care service, I have enjoyed seeing the teamwork between neurologists and emergency medicine physicians. Neurologists rely on the EM physician to inform them of potential stroke patients in the ED, while EM physicians use the neurologist as a guide in treatment management; however, in my short time on the service, I have seen a vast array of opinions on the administration of tPA. Tissue plasminogen activator or alteplase is a fantastic drug that saves lives when used in the right patient population. That is where the controversy lies. What is the right patient population and how do we avoid wasting valuable resources on non-stroke patients?