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Intern Report Collection, Vol. 3

Our ongoing intern report series is the product of first-year EM residents at UT Southwestern exploring clinical questions they have found to be particularly intriguing. For med students & junior residents - if you haven't encountered these issues yet, you will!

practice updates

EKG Practice #2

Ray Fowler, MD is Professor of EM / EMS at UTSW / Parkland. Edited by Alex Koyfman, MD.

Case #1

A 38 year-old female presents about a month after having had epigastric and chest pain that was quite severe for an entire day about a month ago. She took some Zantac and Maalox, felt better, and went to bed. The next day she was weakened, but she gradually felt better and went about her business. In the last 24 hours she has noticed that she has had episodes of lightheadedness and occasional palpitations, so she comes to the ED. Your nurse hands you her ECG. What is your interpretation? ekg2-1

Case #2

A 36 year old male calls EMS due to chest pain and palpitations. Medics come and pick him up, and find him to be having severe chest pain with a systolic of 90. The medics call into BioTel (the online medical control) requesting instructions. They tell me that the man has a history of SVT. I asked them to transmit the ECG, and they sent this: ekg2-2 They are still on-scene, and their ETA will be about 10 minutes once en route. What would YOU do??

practice updates

Ask Me Anything with Scott Weingart, MD (@emcrit)

Live Blog Ask Me Anything with Scott Weingart
 

practice updates

D-List Superbugs: Influenza

Influenza is spread primarily through large respiratory droplets or contamination of surfaces. About 4 days after exposure patients will typically start to develop an abrupt onset of fever, headache, myalgias or dry cough—generally this presentation will be considered an uncomplicated influenza illness. Symptoms usually resolve after 3-7 days from onset. Patients can have a more complicated course if they have primary influenza pneumonia, exacerbation of underlying medical conditions like COPD, or secondary bacterial pneumonia (Strep pneumoniae, Staph aureus, community-acquired MRSA, Haemophilus influenza are the more common pathogens). There is not a validated and widely used decision rule to help distinguish influenza from other viral pathogens based on signs and symptoms. We do know that there is some seasonal variance with influenza being more common in winter months. We also have laboratory tests like respiratory panels to screen for influenza. However, the poor sensitivity and uncertain utility of these tests makes their value in the typical uncomplicated influenza presentation questionable. Treatment recommendations, supported by the CDC, IDSA, and WHO have come under recent scrutiny—we should ALL be familiar with the recent data on influenza treatment. [...]

practice updates

Ask Me Anything with Rob Rogers, MD, FACEP

Live Blog Ask Me Anything with Rob Rogers, MD, FACEP
 

electrocardiography

EKG Practice

Ray Fowler, MD is Professor of EM / EMS at UTSW / Parkland. Edited by Alex Koyfman, MD.

45 male with intense epigastric pain radiating to his left arm with associated NV and diaphoresis. ekg1


55 female with crushing anterior chest pain and diaphoresis. ekg2
ekg3
A sinus tachycardia is present in this 54 year old man with severe chest pain radiating to the left arm.

ekg4


This is a narrow complex tachycardia in a 31 year-old female that is perfectly clock regular. There is no obvious atrial activity seen. The QRS is narrow. ekg5
This 65 year-old woman presents with lightheadedness and worsening dyspnea on exertion. ekg6
This 81 year old man had a syncopal episode. He presents a little confused, GCS 14 (lies with his eyes closed), and is “not right” per his wife. His BP is 110/76, and he has the cardiogram below. ekg7
ekg8
This is an odd 12 lead ECG to have done in this 54 year old man. The rate is profoundly slow, in the 20’s or so. The rhythm is regular. There is no evident atrial activity. The QRS is very widened. ekg9