Emergency Medicine Journal

SEPTEMBER 27, 2023

Coagulation tests of APTT and PT-INR were within the normal range. She had repeated similar episodes of intraoral haematomas after meals, but other parts of the body had never been involved. Laboratory results were white blood cell count of 9000/mm 3 , haemoglobin 14.3 g/dL and platelet count 259 000/mm 3. Angina bullosa haemorrhagica.

75

75

EMergucate

SEPTEMBER 21, 2021

Compass trial Design– double-blind trial involving placebo medication vs study medication, March 2013 to May 2016. Rivaroxaban (2.5mg bd) + … Continue reading →

40

40

Sensible Medicine

DECEMBER 20, 2023

I do daily PT exercises, however a refresher course may help. Sincerely, {Signoff Name:10576} Doctor Adam Cifu James Order for PT is in. Patient “James Smith” In January 2022 I had a severe episode of sciatica. I'm starting to feel a similar twinge in my back. I put in the order for a medrol dose pack as well.

Wellness 88

Wellness Hospitals 88

Emergency Medicine Journal

NOVEMBER 28, 2023

The primary outcome was 30-day mortality; secondary outcomes included admission clotting profile (PT/aPTT). There was no difference in admission PT or aPTT between Oneg and all other groups combined, p=0.12 Data reported as number (percentage), median [interquartile range]. compared to 8.8%; RR 1.72 (95%CI 1.32-2.24), respectively.

Outcomes 40

Outcomes Research 40

JournalFeed

DECEMBER 5, 2020

We cover seat belt sign and CT sensitivity, PT for sciatica, 3% saline or mannitol for pediatric CNS infection with increased ICP, reducing pediatric critical care transport risk, and POCUS for emergency airway management. It’s the JournalFeed Podcast for the week of Nov 23-37, 2020.

Airway Management 52

Airway Management Pediatrics 52

Taming the SRU

FEBRUARY 12, 2024

Notable diagnostics Point-of-care glucose (initial): 274 PT/INR: 47.4/4.9 Unlike these drugs, excessive dosage of a DOAC such as rivaroxaban may not trigger a prolongation of the prothrombin time (PT) or the activated partial thromboplastin clotting time (aPTT) and normal results should not diminish one's concern. [7]

Administration 71

Administration Fractures Anaphylaxis Emergency Department 71

ER Nurses

SEPTEMBER 17, 2018

0 false 18 pt 18 pt 0 0 false false false /* Font Definitions */ @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; Normal.dotm 0 0 1 1110 6329 Distinct SEO Inc 52 12 7772 12.0

40

40

Dr. Smith's ECG Blog

JUNE 17, 2023

1999 Oct;34(4 Pt 1);448-52. Carley et al. What’s the point of ST elevation? Emerg Med J. 2002;19:126-128. Tandberg et al. Observer variation in measured ST-segment elevation. Ann Emerg Med.

EKG/ECG 52

EKG/ECG Documentation/Coding EMS 52

PulmCCM

OCTOBER 3, 2023

However, a large multicenter trial failed to demonstrate a benefit of intensive daily physical therapy in ventilated patients , and even a small signal of harm—when compared to regular (non-intensive) daily PT, which most ICUs do not even attempt.

Outcomes 52

Outcomes Best Practices Wellness 52

Sensible Medicine

DECEMBER 1, 2023

Pt: Don’t the medications have side effects? Pt: I don’t think I want to take it. I would start 10 mg of atorvastatin daily. What do you think? Me: They are generally very well-tolerated medications, and given your cardiovascular risk, the benefits greatly outweigh the harms.

Wellness 81

Wellness Documentation/Coding Outcomes Stroke 81

Pediatric EM Morsels

APRIL 7, 2023

Posterior circulation infarcts can present with nausea, vomiting, ataxia, lightheadedness, headache Laboratory (Webb, 2013, Debaun, 2020) CBC with differential, reticulocyte count, basic metabolic panel, PT/INR, and type and screen Blood culture if infection suspected, hemoglobin S electrophoresis if possible Imaging (Webb, 2013, Debaun, 2020) MRI/MRA (..)

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

ALiEM

NOVEMBER 27, 2023

g/dL BMP, lipase, Alk phos/Bili/ALT/AST, PT/PTT, and lactate : Unremarkable Serum HCG : Negative Urinalysis (UA) : Unremarkable COVID : Negative Case Question: Can you identify the abnormalities on the right upper quadrant (RUQ) ultrasound image? Pelvic : Scant white vaginal discharge and CMT. k/uL Hgb : 10.5

Ultrasounds 64

Ultrasounds Academics Operations OB/GYN 64

ALiEM

NOVEMBER 13, 2023

PT/PTT/INR : 12.0s/32.2/1.04 Laboratory Data CBC w/ differential : Normal BMP : Na 142, K 3.8, Cl 106, HCO3 24, BUN 16, Cr 0.44, Glu 112, Ca 8.5, LFT’s : AST 105, ALT 76, ALP 68, Tbili 0.2 D-dimer : 347 ESR : 62 CRP : 0.75

Academics 80

Academics 80

SCGH ED

SEPTEMBER 2, 2022

CCT 2 Home Metro Wide Contact: Ext.

40

40

EM Guide Wire

JANUARY 15, 2020

If yes, secure airway, support breathing, support circulation Consult vascular/cardiothoracic surgery Patient is stable Confirm diagnosis and evaluate for malignant obstruction CBC, CMP, PT/INR, CXR, CT chest w/contrast Does the patient have a malignant obstruction or thrombosis?

52

52

EMDocs

JULY 11, 2023

Any patient with isolated ↑aPTT but normal PT and platelets. If suspected hemophilia: May see prolonged aPTT, with a normal PT, bleeding time, and platelet count. Adults: Spontaneous bruising, ecchymosis, mucosal bleeding, muscle hematomas, subacute or delayed postpartum bleeding, or any other unexplained bleeding.

Head Injuries 60

Head Injuries Pediatrics Dislocations CDC 60

PEMBlog

OCTOBER 19, 2023

Additional labs ordered per the consultant’s recommendations were notable for elevated PT/PTT, AFP, plasma tyrosine, and urine succinylacetone consistent with a diagnosis of tyrosinemia. Initial labs revealed an AFP that was elevated at 7,000 raising concern for malignancy, so a liver biopsy was performed to exclude malignancy.

Urgent Care 52

Urgent Care Pediatrics Poisoning Wellness 52

EMDocs

NOVEMBER 21, 2023

2006 Jan;129(Pt 1):8-17. Muscle Nerve. 2013 Jan;47(1):41-5. Venance SL, Cannon SC, Fialho D, et al; CINCH investigators. The primary periodic paralyses: diagnosis, pathogenesis and treatment. Miller TM, Dias da Silva MR, Miller HA, et al. Correlating phenotype and genotype in the periodic paralyses. 2004 Nov 9;63(9):1647-55.

Administration 67

Administration 67

Taming the SRU

NOVEMBER 4, 2023

The ISTH tool on MDcalc can be used to assess the presence of overt DIC.

Hyperthermia / Hypothermia 74

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 74

EMDocs

NOVEMBER 27, 2023

UA with mild hematuria, proteinuria, and eosinophils – indicative of nephritis PT/INR & PTT – if evidence of hepatic involvement Cardiac enzymes – if patient has chest pain or other anginal equivalents Consideration of viral hepatitis panel and serology.

EMS 70

EMS Sepsis Burns EKG/ECG 70

Downeast Emergency Medicine

FEBRUARY 9, 2022

2+ PT and DP pulses. The patient was able to isometrically contract the quadriceps muscles but not able to extend the lower leg. He has 5/5 strength to dorsi and plantar flextion bilaterally. No overlying erythema or increased warmth. Sensation to light touch is intact distally. Bedside musculoskeletal ultrasound of his knees was performed.

Ultrasounds 52

Ultrasounds Fractures Operations Emergency Department 52

Taming the SRU

SEPTEMBER 25, 2023

2+ right DP and PT pulses. The patient’s physical exam is notable for significant edema along the medial malleolus of the right ankle. Tender to palpation. Limited dorsiflexion/plantar flexion secondary to pain. Sensation intact to light touch. Able to wiggle toes. Tender to palpation of the right fibular neck.

Fractures 91

Fractures Operations Emergency Department EMS 91

EMDocs

MAY 11, 2024

Risk factors : 10% of ischemic strokes occur in the brainstem 2 Risk factors for ischemic brainstem stroke 3 : Atherosclerosis Hypertension Diabetes Smoking Atrial fibrillation Hyperlipidemia Ischemic heart disease Embolism Dissection Risk variables for hemorrhagic brainstem strokes 3 : Hypertension Anticoagulant use AV malformations Amyloid angiopathy (..)

Stroke 79

Stroke EMS EKG/ECG Radiology 79

EMDocs

OCTOBER 9, 2023

6) Wyckoff MH, Greif R, Morley PT, et al. J Endocrinol. 2017;234(1):T93-T106. 5) Te Riet L, van Esch JH, Roks AJ, van den Meiracker AH, Danser AH. Hypertension: renin-angiotensin-aldosterone system alterations. 2015;116(6):960-975.

Basic Life Support 80

Basic Life Support CPR Fractures Emergency Department 80

Pediatric EM Morsels

MARCH 17, 2023

(I have no reference for this, but I think we can all agree this is prudent!)

CDC 130

CDC Poisoning Pediatrics Shock 130

Emergency Medicine Ireland

FEBRUARY 8, 2021

2018 Dec;37(6 Pt A):1798-1809. References: UTD Article Pironi L, Corcos O, Forbes A, Holst M, Joly F, Jonkers C, Klek S, Lal S, Blaser AR, Rollins KE, Sasdelli AS, Shaffer J, Van Gossum A, Wanten G, Zanfi C, Lobo DN; ESPEN Acute and Chronic Intestinal Failure Special Interest Groups. doi: 10.1016/j.clnu.2018.07.036. 2018.07.036.

Operations 40

Operations Outcomes 40

Mind The Bleep

MAY 12, 2023

L or uncontrolled bleeding or haemodynamically unstable In those with large-volume haematemesis, consideration should be given to airway protection and the need for early intubation for endoscopy. 9 Encephalopathy Look closely for a precipitant and treat accordingly!

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

EMDocs

AUGUST 15, 2023

Give analgesics for pain control but avoid NSAIDs due to their inhibitory effect on platelets Obtain initial labs including CBC, BMP, PT/INR, and fibrinogen. Repeat labs approximately 6 hours after initial control and/or prior to discharge.

Poisoning 79

Poisoning Administration CDC EMS 79

EMDocs

JANUARY 16, 2024

1993;22(2 Pt 2):370-377. Accidental hypothermia [published correction appears in N Engl J Med. 2013 Jan 24;368(4):394]. N Engl J Med. 2012;367(20):1930-1938. doi:10.1056/NEJMra1114208 Weinberg AD. Hypothermia. Ann Emerg Med. doi:10.1016/s0196-0644(05)80467-6 Farkas J. Hypothermia – EMCRIT Project. EMCrit Project.

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

All Ohio EM

NOVEMBER 7, 2018

Some tips for PTA drainage: atomized 4% Lidocaine is quicker and easier than nebulized; take the top off of a Gyn speculum and use it as a light source (let the pt hold it); use a spinal needle – longer, keeps the syringe out of the mouth and gives you more room to work.

Leadership 40

Leadership CDC Shock Fractures 40

EMDocs

JUNE 3, 2023

ECG and laboratory analysis (glucose, CBC, electrolytes, renal/liver function, troponin, PT/PTT) also recommended. Definitive diagnosis of cerebellar infarction is made with MRI of the brain, as CT imaging (both non-contrast and IV contrast) is often unremarkable and has poor sensitivity for cerebellar stroke.

Stroke 72

Stroke EMS Pediatrics EKG/ECG 72

Taming the SRU

APRIL 17, 2023

1990;23(5 Pt 1):829. Dermatology. 2002;205(1):40. Vernon HJ, Olsen EA. A controlled trial of clobetasol propionate ointment 0.05% in the treatment of experimentally induced Rhus dermatitis. J Am Acad Dermatol. Fotedar S, Fotedar V. Green Tobacco Sickness: A Brief Review. Indian J Occup Environ Med. 2017 Sep-Dec;21(3):101-104.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Anaphylaxis Pediatrics 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The ambulance report says "BP continued to drop during transport and pt remained cold and clammy." He described it as "10/10" intensity, radiating across his chest from right to left. EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49.

EKG/ECG 107

EKG/ECG EMS Wellness Operations 107

Mind The Bleep

OCTOBER 20, 2023

2011;134(Pt 9):2456–2477. Lancet Neurol. 2022 Mar;21(3):258-272. doi: 10.1016/S1474-4422(21)00341-0. PMID: 35182511. Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. The motor neuron diseases, Tom Jenkins, Alice Brockington and Pamela J- Shaw.

Wellness 52

Wellness Research 52

PulmCCM

SEPTEMBER 13, 2021

The American journal of physiology 1999, 276(1 Pt 2):H81-88. Pulmonary circulation 2014, 4(2):211-219. Stergiopulos N, Westerhof BE, Westerhof N: Total arterial inertance as the fourth element of the windkessel model.

Burns 40

Burns Stroke Wellness Ultrasounds 40

EB Medicine

AUGUST 6, 2019

Routine PT and PTT levels do not help assess DOACs, as abnormalities on either test can suggest the presence of a DOAC, but the values should not be interpreted as reliable measures of either therapeutic or supratherapeutic clinical anticoagulant effect. Nachi: The DOACs may cause mild prolongation of PT and PTT.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Post Cath ECG: Obviously completing MI with LVA morphology, and STE that meets STEMI criteria (but pt is still diagnosed as "NSTEMI"). No TIMI flow was listed in the report. Other vessel disease included LCX 75% mid and distal, RPDA 75%. Terminal T wave inversion could me some reperfusion, or just part of untreated completing MI.

EKG/ECG 73

EKG/ECG Outcomes Academics Documentation/Coding 73