Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction.

Methodology: 3/5           Usefulness: 3/5 Twerenbold R, et al. J Am Coll Cardiol. 2019 Jul 30;74(4):483-494. Editorial: Evaluating Suspected Acute MI in the Emergency Department: What Is and What Should Never Be. Question and Methods: Prospective international study of the impact on management and patient safety using the ESC 0/1hr high-sensitivity troponin algorithm in the ED for patients […]

Let’s talk about some drugs

Here, we seek to explore some controversial, poorly known, or irrelevant drugs in medicine in a menagerie of drug cocktails. 1. What drugs best treat SVT? A patient presents with the following rhythm strip, they’re totally stable, on no medications and with no significant medical problems. Take a minute, think about how you are going to treat it. Thought about […]

Anxiety, Depression and Everything in Between

In the past 5-10 years we have seen a significant increase in mental health-related complaints in the Emergency Department (ED), and during COVID this is especially noticeable. Historically, we’ve classically been taught to focus on performing safety assessments, and as a result, we don’t often end up doing anything helpful for these patients, or we end up consulting psychiatry for […]

Protocol for lung ultrasound in COVID-19 patients

Lung PoCUS can rapidly diagnose the underlying etiology at the bedside of the acutely dyspneic patient. Lung PoCUS has excellent test characteristics for the diagnosis of pulmonary edema, pneumothorax and pleural effusions allowing the treating physician to rapidly start appropriate therapies. During the COVID19 pandemic PoCUS has other potential advantages of decreasing the need to transport a patient to further […]

Pulmonary Embolism in Pregnancy: Diagnostic Dilemmas

Epidemiology of pulmonary embolism in pregnancy The rate of pulmonary embolism (PE) in pregnancy is 5.4 per 10 000 pregnancies. This is 5x the risk of the general non-pregnant female population The rates of venous thromboembolism change throughout pregnancy: Antepartum: 5.4 per 10 000 Peripartum: 7.2 per 10 000 Postpartum: 4.3 per 10 000 This leads to 0.96 deaths per 100 […]

Braving the Electrical Storm in the ED

This post takes a deep dive into the pathophysiology, presentation and management of electrical storm in the emergency department. The management focuses on patients with implantable cardioverter-defibrillators receiving multiple shocks, patients with polymorphic ventricular tachycardia and refractory ventricular fibrillation. Electrical storm (ES) has varying definitions in the literature depending on whether or not the patient has an ICD (an implantable […]

Learning during COVID-19

During the COVID-19 pandemic, one of the challenges facing residents is continuing to receive high-quality learning during their training. Difficulties such as transitioning to a virtual platform, protecting residents from certain aerosol-generating procedures, and decreased patient volumes make it challenging for learners compared to the pre-COVID era. Here, we explore some strategies to help ensure that residents are progressing along […]

Sepsis and Septic Shock

The Surviving Sepsis Guidelines define sepsis as a “life-threatening organ dysfunction caused by a dysregulated host response to an infection”. Septic shock is further defined as sepsis with hypotension (MAP ≤65) and/or lactate ≥2.0 despite adequate fluid resuscitation(1,2). This definition of septic shock highlights the importance of factoring in both macrocirculatory (blood pressure) and microcirculatory markers (lactate) when treating patients. […]