Point-of-Care Ultrasound diagnosis of Endocarditis

A healthy patient presents to the Emergency Department (ED) where you are working one night. He complains of a four-day history of progressively worsening fatigue, constant and diffuse headache, neck stiffness, fever, chills and night sweats. There was no associated photophobia or phonophobia. He denies any infective symptoms, sick contacts or recent travel. He denies any past medical or surgical […]

Electrical vs Chemical Cardioversion in ED patients with Atrial Fibrillation (RAFF2)

RAFF2 Ian Stiell and colleagues are back at it with atrial fibrillation; The RAFF2 trial (Electrical versus Chemical cardioversion for Emergency Department patients with Atrial Fibrillation (RAFF2); A partial factorial randomized trial) was published in The Lancet this week. Acute atrial fibrillation is an irregular dysrhythmia that should be treated within 48 hours to avoid significant complications such as stroke […]

Congenital Cardiac Disease in the ED

Let’s start off with a case: 29 year old male, HR: 140, BP: 70/40, Temperature of 39.1. Sounds like straight forward, bread-and-butter emergency medicine doesn’t it? That is, until you look at the past medical history: Single Ventricle Hypoplastic RV Left AV Valve Atresia Large Ventricular Septal Defect Patent Formal Ovale Transposition of the Great Arteries Fontan Procedure Ugh. Terrified […]

Focus on POCUS: Heartbreaker. Cardiac Echo in the ED.

For other ultrasound focused cases please see our Ultrasound Archives.  A woman in her 60’s presents to the emergency department on her 7th post-operative day feeling nauseous, vomiting, weak and dizzy. She has just recently underwent a open left hemi-colectomy, end-colostomy formation for recurrent diverticulitis. . Her past medical history is only significant for type 2 diabetes, and her only […]

LVAD’s 101 !

Have a crashing Left Ventricular Assist Device (LVAD) patient in your Emergency Department? Need some help? Want to challenge your residents? The following should help you in your bedside assessment and treatment of the critically ill LVAD patient.   For a thorough description of components, functionality and indications for LVAD’s, check out EDECMO’s blog post for an excellent LVAD overview. […]

Accuracy and Quality of Clinical Decision Rules for Syncope in the Emergency Department: A Systematic Review and Meta-analysis

  Journal Club Summary Methodology:  4/5          Usefulness:  2.5/5 Serrano LA, Hess EP, Bellolio MF, Murad MH, Montori VM, Erwin PJ, Decker WW. Ann Emerg Med. 2010 Oct;56(4):362-373 Abstract Link   This systematic review and meta-analysis of multiple clinical decision rules for syncope, found the pooled sensitivity and specificity for the only 2 externally validated rules (SFSR and OESIL) were lower […]

Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction

Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2/5 Smith SW, Khalil A, Henry TD, Rosas M, Chang RJ, Heller K, Scharrer E, Ghorashi M, Pearce LA. Ann Emerg Med. 2012 Jul;60(1):45-56.e2. Epub 2012 Apr 19. Pub Med Link   This retrospective cohort study of anterior STEMI and Benign Early Repolarization (BER) patients derived and validated a mathematical combination of 3 ECG criteria (R-wave […]