Acute Aortic Syndromes (AAS) are life threatening cardiovascular emergencies that are the bane of every emergency physician’s existence. They are diagnostic challenges due to the clinical presentation being highly non-specific. Computed tomography angiography (CTA), Transesophageal Echocardiography (TEE), and Magnetic Resonance Angiography (MRA) can help accurately diagnose AAS. CTA exposes patients to radiation and large doses of intravenous contrast,
Read More
Thanks to Sergey Motov (@PainFreeED) for the expert review at the end of the post.
Acute, minor musculoskeletal injuries (i.e. non-fracture or dislocations) are frequently seen in the Emergency Department. Aside from ruling out a more severe injury, management often focuses on pain relief or mitigation of pain. Though many analgesic agents exist,
Read More
Assessing fluid responsiveness is essential to guiding resuscitation of critically ill patients. Inferior vena cava (IVC) collapsibility measured by point of care ultrasound (POCUS) has been shown to accurately predict fluid responsiveness in mechanically ventilated patients. However, it’s utility in spontaneously breathing patients is less well established.
Read More
First trimester vaginal bleeding is a common complaint seen in the Emergency Department (ED). Patients are obviously stressed about the possibility of miscarriage while providers are stressed about missing diagnoses such as ectopic pregnancies. There have been multiple studies questioning the interrater reliability of the pelvic examination. But is there added utility to the examination once the presence of an intrauterine pregnancy (IUP) has been established?
Read More
Ascites is the most common complication of liver cirrhosis, and infection of that abdominal fluid, spontaneous bacterial perotinitis (SBP) is both common (reported in 10-30% of hospitalized patient) and deadly, with a mortality rate of 10%. SBP can be diagnosed by analysis of ascitic fluid obtained by a simple bedside diagnostic paracentesis, a procedure well within the scope of all emergency medicine physicians.
Read More
Abusive head trauma is the leading cause of death from child abuse and the leading cause of death from traumatic brain injury. Identification of clinically important traumatic brain injury is essential. The PECARN head trauma rule for children less than 2 years of age includes 6 predictors (PECARN 2009). The predictors of “acting normally as per parents” and “a high-risk mechanism of injury” may be unreliable in infants with abusive head trauma.
Read More
Background: Assessing fluid responsiveness in patients in shock is crucial as fluid balance is important in their management. Identifying patients who are fluid responsive allows us to rapidly increase their cardiac index. However, rapid infusion does not benefit all patients in shock and in some, may be harmful. As a result, it is crucial to identify parameters that can aid in identifying patients who may benefit from volume expansion.
Read More
Background
The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of CT pulmonary angiography (CTPA) for diagnosis. However, despite these algorithms, there is evidence of increasing use of CTPA along with diminishing diagnostic rate (less than 10%).
Read More