What the Heck is Going on with this Pacemaker?!

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What the Heck is Going on with this Pacemaker?!

Pacemakers and implantable cardioverter/defibrillators (ICDs) are fascinating little machines.  They were first placed in survivors of sudden cardiac death in 1980, and over the past several decades have become more complex with increasing abilities to sense, pace and defibrillate.  As the population ages and the prevalence of cardiovascular disease increases, patients with pacemakers and ICDs will present more commonly to the emergency department.  It is imperative that the emergency provider have a framework for troubleshooting these devices.  This post will briefly review the use of the "donut" with an implantable pacemaker, as well as three pacemaker malfunctions the emergency provider may encounter.

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Lungs are Sometimes Better Seen than Heard

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Lungs are Sometimes Better Seen than Heard

An old mentor of mine liked to say "sometimes lungs are better seen than heard."  While he was referring then to good old fashioned chest xray, current literature clearly supports the use of bedside ultrasound as a valuable tool in evaulating the dyspneic patient.  In this lecture, Dr. Jacob Avila discusses the use of the bedside ultrasound in detecting pneumonia, pulmonary embolism, congestive heart failure, and pneumothorax. 

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What do you want to be when you grow up?

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What do you want to be when you grow up?

Wondering which fork in the road to take after your emergency medicine residency? Interested in academics, but would also love to find that sweet job with surf just down the street?  We were fortunate to have a parade of stars for our 2017 emergency medicine career day.  Take a look to find help on buffing your CV, finding your fellowship, evaluating an academic career, or critiquing a contract for a private group. 

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Blood Can Be Very Bad! - How to Read an Emergent Head CT

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Blood Can Be Very Bad! - How to Read an Emergent Head CT

It's 3 AM and EMS brings in a patient with altered mental status found down in the local park. His glucose and vital signs are normal and there is no clear etiology on his exam.  As part of your work up, you order a CT brain to evaluate for a neurologic case.  Unfortunately, teleradiology has been taking up to 90 minutes to give an interpretation on your CT's. As the patient is taken off the scanning table, you quickly peruse his CT and wonder. . . will I be able to identify an emergent diagnosis before my friendly "neighborhood" radiologist?

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Feature Film: Strep Throat - To Treat or Not to Treat? That is the question...

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Feature Film: Strep Throat - To Treat or Not to Treat? That is the question...

Our very own Irish George Clooney shares some pediatric pearls as he discusses the pros and cons of testing for and treating streptococcal pharyngitis including: using the centor criteria in children, test characteristics of the rapid antigen detection test, risks, complications and potential benefits of treating versus not treating and how to discuss these issues with parents. 

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Not Another Patient with Dizziness! - Evidence Based Pearls for Your Practice

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Not Another Patient with Dizziness! - Evidence Based Pearls for Your Practice

Dizziness accounts for 4-5% of all emergency department (ED) chief complaints and 26% of ED patients endorse dizziness in their review of systems.  Although most presentations for dizziness are benign, nearly 200,000 strokes present with dizziness each year in the United States (Edlow et al. 2008).   Misdiagnosis of vertebrobasilar strokes is common, as symptoms may be minimal and patients often change how they characterize their symptoms.  In the video below, Dr. Siket covers a systematic and evidence based approach to guide your workup of this all too common patient.  

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Bud's Common and Simples - Intra-nasal Foreign Bodies

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Bud's Common and Simples - Intra-nasal Foreign Bodies

You stuck what where?!?!   Dr. George "Bud" Higgins shares with us some tricks of the trade regarding evaluating and removing intra-nasal foreign bodies. He discusses some well known maneuvers ("parent's kiss," passing a foley catheter, bayonette forceps) and a more novel approach using intranasal positive pressure gas flow.

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Journal Club May 2017 - Suicide Risk Assessment

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Journal Club May 2017 - Suicide Risk Assessment

Emergency physicians regularly see psychiatric patients who are having suicidal thoughts or engage in non-suicidal self-injurious (NSSI) behavior. In addition to working these patients up medically, it is part of our job to determine who needs emergent evaluation by a psychiatric provider and who is safe for discharge. This is a very important decision, as we do not want to send high risk patients home and keep low risk patients for extended periods of time while they await their evaluation. Balancing this can be difficult - oftentimes it is not obvious where a patient falls on this spectrum. We are taught various decision aids in medical school to help us risk stratify these patients - but how do they perform on emergency department patients? For this month's journal club, we looked at three papers that examine three different decision aids to help elucidate this issue.

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Bud's Common and Simples - Fingernail Avulsion Repair

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Bud's Common and Simples - Fingernail Avulsion Repair

Fingernail avulsions constitute a unique fingertip injury as they have the potential to result in long term nail deformity and impaired function if not repaired properly.  In order to treat these injuries effectively, the treating provider must understand the anatomy of the nail bed, nail root, and the intricacies of nail growth. In this brief video, Dr. George "Bud" Higgins shares with us how to assess and treat this injury to optimize our patient's chances for successful nail regrowth, function and cosmesis.

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