Ever wonder where the the current American Heart Association and American Stroke Association (AHA/ASA) guidelines for thrombolysis in acute ischemic stroke come from?   Included is a summary of the landmark studies that have contributed to these recommendations (NINDS& ECASS III) as well as a review of IST-3. 

Chvostek’s sign is momentary contraction of the nose and/or lips in response to tapping the facial nerve at the angle of the jaw.  Associated with hypocalcemia, it has been found to be poorly sensitive and specific.  It is seen in 10-25% of healthy individuals with normal calcium levels, whereas approximately one third of patients with hypocalcemia will not demonstrate this sign.

What may appear (and smell) impressive in the ED does not always require emergent intervention, yet understanding how to determine the severity of lower gastrointestinal bleeding, need for aggressive resuscitation, and diagnostic/consultant resources are key for the emergency provider.

For some, this topic may be more bread and butter than others. Many of you may work in cold areas where you are likely to see patients with hypothermia on a regular basis, especially in the winter. Whether you work shifts in a mountainous region or are simply catching up on EM topics while studying for boards in your in you flip flops by the beach, here are a few pearls regarding patients who present with hypothermia and their management.