The Crashing Trauma Patient
How do you care for the crashing trauma patient? This post takes you through the critical resuscitation step-by-step.
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Taking Ownership of the Ventilator – How to Manage and Troubleshoot
Your overnight junior calls for your help with his decompensating intubated patient. The patient is a 54 year-old male with a history of COPD who was intubated ten minutes ago. The ventilator is alarming due to high pressures. The patient’s current vitals are HR 140, BP 80/50, SpO2 82%. The ventilator settings are VCV rate 12, tidal volume 450, PEEP 15, FiO2 100%. You quickly disconnect the circuit but the patient is not improving. What do you do next?
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Subtle ECG Findings in ACS: Part III Benign Early Repolarization vs. Anterior STEMI
Welcome to the third blog post in a series on subtle ECG findings in ACS. This post about mimics: benign early repolarization (BER) and the anterior STEMI. Each of these can mimic the other. The problem is that one of these diagnoses is deadly and the other is a normal variant.
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Subtle ECG findings in ACS: Part II Hyperacute T-Waves
What if you could identify a patient with complete coronary vessel occlusion almost immediately after it occurs, before the ST segments begin to elevate? What if you could pick up the very subtle, early MI? We know that early recognition and intervention improves outcomes in patients with coronary artery occlusion. Sometimes patients presenting with ACS are obvious. Sometimes it seems that the patient has read the textbook. However, more often than not, patients are not obvious, especially in the early stages of ACS. That is why we are concerning ourselves with subtlety.
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Central Retinal Artery Occlusion
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.
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ECG Analysis: Where do we go wrong and how can we improve?
Pearls and pitfalls for EKG Analysis in the Emergency Department
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The Elevated Troponin: What else besides ACS could cause troponin elevation?
The increased troponin used to be a straight ticket to the cardiology service. Now, the picture isn’t so clear. What do you need to consider in the patient with elevated troponin?
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The Anticoagulated Patient with Head Trauma: What’s the Disposition?
What do you do with the head trauma patient who is anticoagulated? Do you discharge the patient, observe and repeat CT, or admit the patient? This post evaluates this question and more.
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Endophthalmitis Highlights
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.
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Hemolytic Uremic Syndrome (HUS): Pearls and Pitfalls
Hemolytic uremic syndrome is a potentially deadly disease, comprised of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (AKI). This post evaluates the pathophysiology, evaluation, and management of HUS.
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