Fri, 02/21/2020 - 3:00am

You are working at a community trauma center when an elderly male is brought to the ED after being struck by a car.  The patient is complaining of right sided chest pain and is in respiratory distress. He has a patent airway, is breathing spontaneously and is normotensive.  He is confused and not oriented to place or time. A chest x-ray does not reveal a pneumothorax, but does reveal 5 contiguous rib fractures. The patient is likely to require intubation due to the increased work of breathing.  You review the patient's chart and note that he has a POLST on file indicating a DNR/DNI status as well as identifying his daughter as a medical power of attorney who may override the POLST. A nurse lets you know the patient’s family has arrived.  You wonder how the presence of the POLST form will influence your conversation with the family.

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Thu, 02/20/2020 - 5:00am

Review of Major ECG findings from last week's Tintinalli Club for Valentine's Day 

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Wed, 02/19/2020 - 5:00am

 

A 24 yo F with history of gallstones presents to the ED with RUQ pain

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Tue, 02/18/2020 - 12:39pm

Most patients presenting to the ED with a headache have a simple primary headache: tension, migraine, or cluster. Detecting the "other" etiolgies for headache, which can result in neurologic devastation or death, is often a diagnostic challenge. He we give some quick hits for one of the "can't miss" headaches, how it presents, and how to diagnose it.

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Mon, 02/17/2020 - 5:00am

Unstable bradycardia?  Complete heart block?  No worries - we've got you covered with this pictoral guide of how to place a transvenous pacer.

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Sat, 02/15/2020 - 5:00am

 

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Fri, 02/14/2020 - 3:34am

 

Venous thromboembolism is considered one of the most preventable causes of in-hospital death. Venovenous extracorporeal membrane oxygenation (VV ECMO) utilization for severe respiratory failure has increased in the decade following the 2009 influenza A H1N1 pandemic and the publication of the CESAR trial.1 The interaction between a patient’s blood and the ECMO circuit produces an inflammatory response that can provoke both thrombotic and bleeding complications. In a systematic review of patients with H1N1 treated with VV ECMO published in 2013, the incidence of cannula-associated deep venous thrombosis (CaDVT) was estimated to be as low as 10 percent; however, more recent data suggests the incidence of venous thrombosis after decannulation is much higher. Additionally, a significant proportion of CaDVT are distal thrombi located in the vena cava, which would be missed with a traditional ultrasound diagnostic approach after decannulation from VV ECMO.  

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Thu, 02/13/2020 - 5:00am

Your patient appears intoxicated but their ethanol level is ZERO ... think toxic alcohols 

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Wed, 02/12/2020 - 7:00am

A 61 yo female with a history of DM presents with 3 days of severe R ear pain.

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Tue, 02/11/2020 - 6:22pm

A 55 year old male presents to the ED with complaints of anterior chest pain radiating through to the thoracic area X 2 days...you mentally run through a check list of the potential "red flag" signs/symptoms for serious back pain before you enter the room. Will this be another benign musculoskeletal pain or something more sinister?

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