Category: PGY4

I had several discussions in ED regarding blood transfusion in anemic patients. My argument is that if patient does not have any acute symptoms (SOB, feeling faint, tachycardia, Cardiac ischemia, …), there is no need to emergently

Hematology PGY1 PGY2 PGY3 PGY4

We are usually observing patients in emergency department in length due to biphasic reaction. There are 2 articles published during last 6 months and they emphasized regarding of  how common is biphasic reaction and mortality of this reaction!

Anaphylaxis PGY1 PGY2 PGY3 PGY4 Uncategorized

Cardiology PGY1 PGY2 PGY3 PGY4

NEJM published a study regarding appropriate MAP among patients with septic shock. Originally MAP of 65 was a target but the Surviving Sepsis Campaign guideline was recommending patients with HTN, may have benefit for higher

PGY1 PGY2 PGY3 PGY4 Sepsis

NEJM published The ProCESS study. Basically, this study aimed to challenge EGDT by Manny Rivers in 2001, a very prestigious and novel approach to septic patient in ED. The EGDT was ED based approach. although some of the components were very difficult to acheived in ED such as Scvo2. The EGDT study showed 16% reduction in mortality, but Rivers faced lots of questions including feasibility of this approach in ED, and necessity of blood

Infectious Disease PGY1 PGY2 PGY3 PGY4

General EM PGY1 PGY2 PGY3 PGY4

This is a challenging question that always comes up in patients with food bolus. What evidence do we have to recommend Glucagon in this situation? is this another version of Kayexalate in case of hyperkalemia? 😉

GI PGY1 PGY2 PGY3 PGY4

PGY1 PGY2 PGY3 PGY4 Trauma

Cardiology PGY1 PGY2 PGY3 PGY4

As much as I read the literature, I really don’t know the BP is my friend or enemy. If you look at the Stroke guideline published in 2013, their recommendation for lowering  BP is”not to lower the blood pressure during the initial 24 hours of acute ischemic stroke unless the blood pressure is >220/120 mm Hg” but there is no reference to

Neurology PGY1 PGY2 PGY3 PGY4

Neurology PGY1 PGY2 PGY3 PGY4

Discharge Against Medical Advice, Pitfalls and Troubleshooting. There is a very interesting article from JAMA in Nov. 2013, explaining of misconception and how misleading is information regarding discharge patient with AMA. I always discuss with residents that signing an AMA form does not mean anything unless you document the patient’s condition and mental status and details of your discussion in medical record.

General EM PGY1 PGY2 PGY3 PGY4

PGY1 PGY2 PGY3 PGY4 Pulmonary

General EM PGY1 PGY2 PGY3 PGY4

Orthopedics PGY1 PGY2 PGY3 PGY4

Orthopedics PGY1 PGY2 PGY3 PGY4

PGY1 PGY2 PGY3 PGY4 Pulmonary

Pain management in ED is a challenging topic. Teaching residents to start with NSAIDS vs Narcotics and Ibuprofen- Toradol vs Morphine- Dilaudid , always could be a place for discussion/argument.

General EM PGY1 PGY2 PGY3 PGY4

I was working on LP study that we did, and found this article from JAMA, very informative. http://jama.jamanetwork.com/article.aspx?articleid=203808  

Neurology PGY1 PGY2 PGY3 PGY4

MMWR in latest Grand round section discussed the options for gonorrhea treatment and their recommendation in case of  cephalosporin allergy,

Infectious Disease PGY1 PGY2 PGY3 PGY4

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

PGY1 PGY2 PGY3 PGY4 Radiology

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:

Neurology PGY1 PGY2 PGY3 PGY4

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.

Cardiology PGY1 PGY2 PGY3 PGY4

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:

PGY1 PGY2 PGY3 PGY4 Toxicology

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…

Cardiology PGY1 PGY2 PGY3 PGY4

 

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

Cardiology PGY1 PGY2 PGY3 PGY4

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…

PGY1 PGY2 PGY3 PGY4 Radiology

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%).

Neurology PGY1 PGY2 PGY3 PGY4

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)

Cardiology PGY1 PGY2 PGY3 PGY4

Cardiac arrest PGY3 PGY4

Pediatrics PGY1 PGY2 PGY3 PGY4

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,

Hematology PGY3 PGY4

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!!!

Cardiology PGY3 PGY4

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…

Cardiology PGY1 PGY2 PGY3 PGY4

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…

PGY1 PGY2 PGY3 PGY4

Cardiology PGY3 PGY4

Cardiology PGY1 PGY2 PGY3 PGY4

Diabetes PGY1 PGY2 PGY3 PGY4

Diabetes PGY1 PGY2 PGY3 PGY4

Cardiac arrest PGY1 PGY2 PGY3 PGY4

PGY1 PGY2 PGY3 PGY4 Trauma

Pediatrics PGY1 PGY2 PGY3 PGY4

Anaphylaxis PGY1 PGY2 PGY3 PGY4

PGY1 PGY2 PGY3 PGY4 Seizure

PGY1 PGY2 PGY3 PGY4 Pulmonary VTE

Diabetes PGY1 PGY2 PGY3 PGY4

PGY1 PGY2 PGY3 PGY4 Sepsis

Cardiology PGY1 PGY2 PGY3 PGY4

PGY1 PGY2 PGY3 PGY4 Trauma

Infectious Disease Pediatrics PGY1 PGY2 PGY3 PGY4

   

Multimedia PGY2 PGY3 PGY4 VTE

General EM PGY3 PGY4

Infectious Disease PGY1 PGY2 PGY3 PGY4

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:

PGY1 PGY2 PGY3 PGY4 Toxicology

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.

Pediatrics PGY3 PGY4 Uncategorized

Pediatrics PGY1 PGY2 PGY3 PGY4

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

Diabetes PGY1 PGY2 PGY3 PGY4

Cardiac arrest PGY3 PGY4

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

PGY3 PGY4 Sepsis

Top Ten Mistakes in Residency by: Peter Deblieux

Audio PGY1 PGY2 PGY3 PGY4

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.

Diabetes PGY1 PGY2 PGY3 PGY4

ACEP’s Video presentation of Dr. Greg Henry and Dr. Gillian Schmitz discussing the top ten documentation mistakes.

Multimedia PGY1 PGY2 PGY3 PGY4

Emergency-Medicine-Past-and-Future by: Peter Rosen

Audio PGY1 PGY2 PGY3 PGY4

How to do Lung Ultrasound to rule out Pneumothorax!

1. Select your probe:
Linear probe, or vascular probe with low penetration and high frequency.

 

PGY3 PGY4 Ultrasound

PGY4 Ultrasound

Multimedia PGY1 PGY2 PGY3 PGY4

Which Anti-emetic for Undifferentiated Vomiting By: Ingrid Lim

Audio PGY1 PGY2 PGY3 PGY4