A patient presents with chest pain and hypotension. EKG demonstrates an irregularly irregular rhythm, absent p waves. Is it time to cardiovert? Let's review the management of atrial fibrillation.
The HEART score and pathway have revolutionized evaluation of the chest pain patient in the ED. This pathway can reduce risk of missed major cardiovascular event to < 1%. Many centers utilize the HEART pathway; however, do the score and pathway have a weakness?
Pulmonary embolism (PE) is classically a life-threatening diagnosis, often considered in the work-up of patients with chest pain or dyspnea. Initial mortality rates of missed, untreated PE has been quoted as high as 26%, based on a 1960 study. This disease is common, with 400,000 patients affected...
A 59 year-old male presented to the emergency department with a chief complaint of difficulty concentrating and loss of vision. He had presented to the same facility the day prior for chest pain, chills, and a cough. During his prior visit, the patient underwent a chest x-ray which demonstrated a co...
Looking deeper into the art of EKG reading...Atypical STEMI patterns and STEMI equivalents to consider when the triage nurse hands you an EKG and says "chest pain", "dizziness", or "syncope"
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 ...
Two cases, where patients return with crushing chest pain to a different ED, and both patients’ ECGs show ST elevation with reciprocal changes. What was missed on the first visit? Could the initial ED physician have done anything differently?
A 64 year-old woman with past medical history of diabetes mellitus type 2 that is well-controlled on insulin, hypertension, and asthma presents with 1 week of shortness of breath and cough productive of blood-tinged sputum. The shortness of breath became suddenly worse about an hour ago as she was w...
