Acad Emerg Med, Feb 2013 published a Canadian retrospective cohort study reviewed patients with ECG, presented to ED with atrial fibrillation. The Outcome measure was mortality in short and long term (30 , 90 , 365 days) among patients with atrial fibrillation who had different primary ED diagnosis for their visits. (more…)
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Mortality of Patients With Atrial Fibrillation and an Alternative Primary Diagnosis
March 4, 2013 by Pourmand
Category Cardiology | Tags: | Comments Off
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PCN resistant Gonorrhea
February 23, 2013 by Pourmand
MMWR in latest Grand round section discussed the options for gonorrhea treatment and their recommendation in case of cephalosporin allergy,
Category Infectious Disease, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Oral Contrast and LOS
February 19, 2013 by Pourmand
and the question is:
Does limiting oral contrast decrease emergency department length of stay? we know the answer is YES, but this is something that we can share with our surgical consultants and as well Radiology colleagues
Category PGY1, PGY2, PGY3, PGY4, Radiology | Tags: | Comments Off
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ACEP Clinical Policy: Asymptomatic HTN in ED
February 19, 2013 by Pourmand
There is a new clinical Policy that Published in Feb, Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood Pressure. There was always a big ? regarding triage and disposition of these patients. There is no great data even on this clinical policy but at least we have some references for that. They answered to following questions:
(more…)Category Cardiology | Tags: | Comments Off
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Ketorolac in the Treatment of Acute Migraine: A Systematic Review
February 1, 2013 by Pourmand
There are different approaches to Migraine HA, Narcotics, Triptans, NSAIDS, Steroids, … but my approach is combination of Metoclopramide and Diphenhydramine.
Headache “The Journal of Head and Face Pain” Published a Systematic Review regarding Toradol and Migraine headache in Jan, and the conclusion is: (more…)
Category Neurology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Challenges regarding Troponin
January 3, 2013 by Pourmand
This is the last update in 2012, but I am happy to end this year with one of the most challenging topics in medicine. The article is from J Am Coll Cardiol in Dec. You can find the Full text link here
1. Remeber: Troponin elevation imparts a worse prognosis, irrespective of the underlying etiology. (more…)Category Cardiology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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CO Poisoning, New pracice guideline
December 4, 2012 by Pourmand
Am J Respir Crit Care Med published a Practice Recommendations in the Diagnosis, Management and Prevention of Carbon Monoxide Poisoning in Oct 2012. We are almost there to see CO poisoning again, Just some points for quick look: (more…)
Category PGY1, PGY2, PGY3, PGY4, Toxicology | Tags: | Comments Off
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aVR: The most Ignored Lead
October 23, 2012 by Pourmand
JACC in 2001 published an article that nicely explained the necessity of interpreting lead aVR in clinical setting. There are 3 categorizes that we should consider in this regard:1. acute coronary syndromes, 2. acute PE, 3. arrhythmia. I strongly recommend you to take a look to the following link
Category Cardiology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Typical Vs Atypical Chest pain
October 19, 2012 by Pourmand
What does typical chest pain mean? Traditionally, we thought that midsternal chest pain with radiation to left arm and increased with exertion, we just had another discussion on this topic on our grand round and all the studies and even (more…)
Category Cardiology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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CONTRAST CT or NON CON CT?
October 2, 2012 by Pourmand
That is the question: contrast CT or non contrast CT? it is very difficult sometimes to answer, but for some facts such as r/o of appy, divericulitis and other pathologies, why do we need Contrast CT? as an emergency physician, it is a matter of 2-4 hours of delayed disposition and increased LOS, more cost, more complications (Allergic reaction , Renal failure,..). I found this article very useful at least for acute appendicits, hope more come from our radiology colleagues
Category PGY1, PGY2, PGY3, PGY4, Radiology | Tags: | Comments Off
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Transient Ischemic Attack
October 1, 2012 by Pourmand
TIA is a huge dilemma in ED. It could be challenging from definition to workup to disposition, but recent article in clinics of north America, reviewed the pitfalls in diagnosis and disposition of patients with TIA. TIA is important because there is a chance of Stroke within 48 hours (5%). (more…)
Category Neurology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Hypertension treatment
August 19, 2012 by Pourmand
What is your favorite hypertension numbers to treat in ED? there are a lots of controversies regarding the exact number to start treatment in ED but recent Cochrane review on mild HTN suggest that antihypertensive agents used in the treatment of adults with hypertension stage I (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) (more…)
Category Cardiology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Cardiac Arrest Survival Is Rare without Prehospital Return of Spontaneous Circulation
August 14, 2012 by Pourmand
Wow. This is the third one, after 2 articles that showed Epi in prehospital really does not decrease mortality , now this retrospective study presenteddata that none of patients with asystole and no (more…)
Category Cardiac arrest, PGY3, PGY4 | Tags: | Comments Off
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Early Administration of Systemic Corticosteroids in Children With Asthma Exacerbation
July 24, 2012 by Pourmand
July 2012: Annals of Emergency Medicine:
Early Administration of Systemic Corticosteroids Reduces (more…)
Category Pediatrics, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Complications Associated with Sickle Cell Trait
June 24, 2012 by Pourmand
We usually believe that pt with sickle cell trait is not as important as SCD(HbSS). In sickle cell trait, RBC has normal life span (120 vs 20) and no vaso-oclusive crisis. But article in the American Journal of Medicine, discussed a series of serious complication that can affect this type of patient ranging from hematuria, renal papillary necrosis, (more…)
Category Hematology, PGY3, PGY4 | Tags: | Comments Off
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EKG differentiation of early Repol vs STEMI
June 4, 2012 by Pourmand
Annals of Emergency Medicine published an article which it provided a formula to determine if we can differentiate between STEMI vs Early Repolarization. I really do not know in an acute setting I am able to sit down and calculate this but sometimes in terms of training it could be fun to do this practice!!! (more…)
Category Cardiology, PGY3, PGY4 | Tags: | Comments Off
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SYNCOPE vs Near SYNCOPE
May 20, 2012 by Pourmand
I read this article long time ago but I had a discussion with one of my resident and to give her reference I would like to have it here. Basically this study showed that Syncope and Near syncope has same critical interventions or adverse outcomes. This term should be taking care as we care about syncope.
Category Cardiology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Low Back Pain
May 17, 2012 by Pourmand
Very detail and informative article regarding Low Back Pain. I believe this article should be read by patients and physicians, and physicians can summarize this for their patients. This is not new but still covers EBM by NEJM.
Category PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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New Concepts in the Assessment of Syncope
May 16, 2012 by Pourmand
There is a State-of-the-Art Paper in the latest edition of Journal of the American College of Cardiology, May 2012.The title of article is New Concepts in the Assessment of Syncope. The authors perspective was based on the presence of a syncope specialist (“the right physician”), adequate equipment including online prompting tools and logistics (“the right place”), and optimal organization (“the right time”), as exemplified in a syncope facility, have been shown to improve at least short-term outcomes.
Category Cardiology, PGY3, PGY4 | Tags: | Comments Off
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What is the role of Morphine in Flash Pulmonary Edema?
May 11, 2012 by Pourmand
We always taught that Morphine can decrease preload and can help with anxiety and pain in acute flash pulmonary edema. But evidence does not support this Claim. (more…)
Category Cardiology, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Standards of Medical Care in Diabetes: 2012
April 15, 2012 by Pourmand
This is the Standards of Medical Care in Diabetes: 2012 by American Diabetes Association (ADA). There are a lots of useful information can help for new criteria for diabetes and so on.
Category Diabetes, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Comparison of arterial blood gas vs. venous blood gas
April 15, 2012 by Pourmand
This is another article regarding comparison of VBG vs ABG. “Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment”. The other one was in critically ill patient but this one is among patient with diverse medical conditions. (more…)
Category Diabetes, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Prehospital Epinephrine Use and SurvivalAmong Patients With Out-of-Hospital Cardiac Arrest
April 6, 2012 by Pourmand
In October 2011, I reviewed an interesting article in Resuscitation, September 2011 regarding use of Epinephrine in per-hospital setting, ,now we have another study published in JAMA, March 2012. (more…)
Category Cardiac arrest, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Pan-Scan for detection of injuries in patients with major blunt trauma
March 19, 2012 by Pourmand
We usually make fun of this topic such as how about have a ct scan in triage and etc.. This is a European study that shows the pan-scan algorithms reduce, but do not eliminate, the risk of missed injuries, and they should not replace close monitoring and clinical follow-up of patients with major trauma.
Category PGY1, PGY2, PGY3, PGY4, Trauma | Tags: | Comments Off
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Clindamycin or Bactrim for pediatric skin and soft-tissue infections
March 5, 2012 by Pourmand
This is a retrospective cohort study between 2004-2007 among patients who received a treatment with clindamycin, trimethoprim-sulfamethoxazole, or a β-lactam for their skin and soft-tissue infections. (more…)
Category Pediatrics, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Guidelines for the Assessment and Management of Anaphylaxis
March 1, 2012 by Pourmand
I am teaching this topic to medical students, interns, and residents every month and I found this valuable guideline by World Allergy Organization. (more…)
Category Anaphylaxis, PGY1, PGY2, PGY3, PGY4 | Tags: | Comments Off
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Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus
March 1, 2012 by Pourmand
This study is interesting because Maryland EMS has a protocol to give Midazolam IM in prehospital setting. The New England journal published on Feb,16, 2012 a double-blind, randomized study comparing IM Midazolam versus IV Lorazepam for children and adults in status epilepticus. (more…)
Category PGY1, PGY2, PGY3, PGY4, Seizure | Tags: | Comments Off
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Bleeding in patients using new anticoagulants or antiplatelet agents: risk factors and management
February 20, 2012 by Pourmand
This is a link to an article form Netherlands, on management of bleeding in patients who just started on different antiplatelet agents. (more…)
Category PGY1, PGY2, VTE | Tags: | Comments Off
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Normalization of Vital Signs Does Not Reduce the Probability of Acute Pulmonary Embolism
February 19, 2012 by Pourmand
Jeffry Kline is famous for his research on PE and his latest article in Academic Journal of Emergency Medicine(Jan 2012) is opening another window to PE regarding Normalization of Vital Signs Does Not Reduce the Probability of Acute Pulmonary Embolismin Symptomatic Emergency Department Patients.
Category PGY1, PGY2, PGY3, PGY4, Pulmonary, VTE | Tags: | No Comments
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Focused Cardiac Ultrasound in the Emergent Setting
February 5, 2012 by Pourmand
American Society of Echocardiography (ASE) and the American College of Emergency Physicians (ACEP) described the important role of focused cardiac ultrasound (FOCUS) in patient (more…)
Category Cardiology, Ultrasound | Tags: | No Comments
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Hyperglycemia in Hospitalized Patients, An Endocrine Society Clinical Practice Guideline
January 23, 2012 by Pourmand
The Journal of Clinical Endocrinology & Metabolism published a practice guideline in Jan.2012. Focus of this guideline is management of hyperglycemia in (more…)
Category Diabetes, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Seizure? Look for PE!!!
January 14, 2012 by Pourmand
This is a link to acep news for a presentation in American Epilepsy Society, 1% of patients diagnosed with pulmonary embolism during a 5-year retrospective study had PE
http://www.acepnews.com/single-view/0addee7cac26f722aa1b28c431b5718f.html?tx_ttnews[tt_news]=945
Category VTE | Tags: | No Comments
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Effective Antibiotic Treatment Prescribed by Emergency Physicians in Severe Sepsis or Septic Shock
January 14, 2012 by Pourmand
Journal of Emergency Medicine published an article with title of “Effective Antibiotic Treatment Prescribed by Emergency Physicians in Patients Admitted to the Intensive Care Unit With Severe Sepsis or Septic Shock” in Dec,2011. (more…)
Category PGY1, PGY2, PGY3, PGY4, Sepsis | Tags: | No Comments
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Cardiac arrest and prognosis
December 22, 2011 by Pourmand
This is one of the challenging topics in EM. when should you stop CPR? what parameters do you have to continue versus terminate CPR? (more…)
Category Cardiology, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Cervical Spine MRI in Alert, Neurologically Intact Trauma Patients
December 16, 2011 by Pourmand
Probably you had this dilemma before. Patient involved MVC with midline neck tenderness and negative CT scan. Now, what should I do? Should I clear and remove c-collar or consult with trauma. There are 2 approaches that trauma surgeons usually do. 1:MRI and/or 2: Flex-ex xray. (more…)
Category PGY1, PGY2, PGY3, PGY4, Trauma | Tags: | No Comments
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Prediction of Pneumonia in a Pediatric Emergency Department
December 14, 2011 by Pourmand
I thought I posted this before but I did not, Pediatrcis 2011, prospective cohort study with 2574 patients under 21 years old. Interestingly, 16 % of patients had radiographic pneumonia. (more…)
Category Infectious Disease, Pediatrics, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Diagnosis and Therapy of Massive PE
December 4, 2011 by Pourmand
Category Multimedia, PGY2, PGY3, PGY4, VTE | Tags: | No Comments
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Emergency Hospitalizations for Adverse Drug Events
December 4, 2011 by Pourmand
To estimate the frequency and rates of hospitalization after emergency department visits for adverse drug events in older adults between 2007-2009. (more…)
Category General EM, PGY3, PGY4 | Tags: | No Comments
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New LBBB and STEMI
November 28, 2011 by Pourmand
There are lots of questions raised recently regarding activation of cath. lab in the setting of new LBBB or presumed new LBBB. It is really challenging when you have a patient with chest pain and there is no old EKG to compare findings of LBBB. (more…)
Category Cardiology | Tags: | No Comments
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Actual or the corrected serum sodium in DKA!
November 22, 2011 by Pourmand
The anion gap is representative of positive versus negative charges. when we are calculating anion gap, we are calculating a balance between positive and negative charges. correcting (more…)
Category Diabetes, PGY1, PGY2, PGY3 | Tags: | No Comments
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MRSA Therapy! New Guideline
November 16, 2011 by Pourmand
IDSA (Infectious Diseases Society of America) published a new guideline this year for treatment of soft tissue infections and MRSA. (more…)
Category Infectious Disease, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Kocher Criteria
November 13, 2011 by Pourmand
Kocher Criteria is the best way to diagnose septic arthritis in children (more…)
Category Pediatrics, PGY1, PGY2 | Tags: | No Comments
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Lumbar Puncture in febrile infant
November 13, 2011 by Pourmand
Is a lumbar puncture necessary when evaluating febrile infants (30 to 90 days of age) with an abnormal urinalysis?
There is a new study in Peds Emergency care which it describes a retrospective study among infants 1 month to 3 months old (more…)Category Pediatrics, PGY1, PGY2 | Tags: | No Comments
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bedside Ultrasound and cardiac mass
November 11, 2011 by Pourmand
This is my case report with Keith Boniface on cardiac angio-sarcoma:
Incidental Identification of Right Atrial Mass Using Bedside Ultrasound: Cardiac Angiosarcoma
Category Ultrasound | Tags: | No Comments
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CO Poisoning
November 5, 2011 by Pourmand
I had a patient with Carbon Monoxide poisoning. Patient had mental status changes and was unresponsive.We transferred patient to a hyperbaric center and this is the review that I did with my resident and student for Carbon Monoxide poisoning, mainly from Tintinalli’s: (more…)
Category PGY1, PGY2, PGY3, PGY4, Toxicology | Tags: | No Comments
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Children at very low risk of TBI per PEACRN
November 1, 2011 by Pourmand
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The goal of study was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary. (more…)
Category Pediatrics, PGY3, PGY4, Uncategorized | Tags: | No Comments
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Pediatric UTI; Practice guideline from AAP
October 31, 2011 by Pourmand
Recently, AAP published a practice guideline on “Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children (more…)
Category Pediatrics, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Are arterial and venous samples clinically equivalent….
October 27, 2011 by Pourmand
Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients?
another study on VBG vs ABG, I am sure in ED we almost agreed that a lot of ABG could be replaced by VBG but still among our consultant, this is not as clear as for us. this study (more…)Category Diabetes, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Effect of adrenaline on survival in out-of-hospital cardiac arrest
October 22, 2011 by Pourmand
This is a very interesting study regarding usage of epinephrine in out of hospital setting. This is probably the first control trial in human post cardiac arrest. The study is about (more…)
Category Cardiac arrest, PGY3, PGY4 | Tags: | No Comments
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Volume Status in Septic Shock
October 22, 2011 by Pourmand
How do we measure the fluid status in a patient with shock? This usually measures with CVP or Ultrasound. CVP measurement is possible when we have a central line(subclavian or intra-jugular). Ultrasound brought a quick assessment of volume status or fluid (more…)
Category PGY3, PGY4, Sepsis | Tags: | No Comments
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Top Ten Mistakes in Residency
October 21, 2011 by admin
Top Ten Mistakes in Residency
by: Peter DeblieuxCategory Audio, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Diagnostic Accuracy of VBG in DKA
October 19, 2011 by Pourmand
We all know that VBG can be replaced with ABG for a lot of reasons, but our consulatants are still asking for ABG in DKA, COPD, Asthma and etc. I will post some data that show VBG is as good as ABG unless you have a patient under vent.
Diagnostic Accuracy of Venous Blood Gas Electrolytes for Identifying Diabetic Ketoacidosis in the Emergency Department.Category Diabetes, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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SURVIVING SEPSIS CAMPAIGN GUIDELINES
October 11, 2011 by Pourmand
Category PGY1, PGY2, Sepsis | Tags: | No Comments
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Top Ten Documentation Mistakes
October 11, 2011 by Pourmand
ACEP’s Video presentation of Dr. Greg Henry and Dr. Gillian Schmitz discussing the top ten documentation mistakes.
Category Multimedia, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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EKG interpretation Recognizing STEMI
October 10, 2011 by Pourmand
Category Multimedia, PGY1, PGY2 | Tags: | No Comments
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Emergency Medicine Past and Future
October 10, 2011 by Pourmand
Emergency-Medicine-Past-and-Future
by: Peter RosenCategory Audio, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Fast Track
October 10, 2011 by Pourmand
How to do Lung Ultrasound to rule out Pneumothorax!
1. Select your probe:
Linear probe, or vascular probe with low penetration and high frequency.
(more…)Category PGY3, PGY4, Ultrasound | Tags: | No Comments
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Lung ultrasound in critically ill patients
October 6, 2011 by Pourmand
Lung ultrasound in critically ill patients: Comparison with bedside chest radiography. This study was done in Greece and their finding is in general ICU population lung ultrasound (more…)
Category PGY4, Ultrasound | Tags: | No Comments
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Anaphylaxis and Angioedema
October 6, 2011 by Pourmand
Category Multimedia, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Which Anti-emetic for Undifferentiated Vomiting
October 6, 2011 by Pourmand
Which Anti-emetic for Undifferentiated Vomiting
By: Ingrid LimCategory Audio, PGY1, PGY2, PGY3, PGY4 | Tags: | No Comments
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Welcome to Emergency Medicine Education
October 4, 2011 by admin
Welcome to Emergency Medicine Education(EME). This is my first post. Finally, after a long way, I created something under my name. I hope you enjoy visiting this website and I(we) can give some Evidence Based Medicine (EBM) through this site. Ali
Category Uncategorized | Tags: | No Comments
