Diagnostics: Flex your D Dimer

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Diagnostics: Flex your D Dimer

In times of COVID, a Dimer of 3000 is nothing to look twice about, however there was an earlier (and future) time where the D Dimer is the hallmark of pulmonary embolism risk stratification. Dr. Comiskey breaks how how this once dichotomous tool has recent data to increase its specificity in elderly patients, pregnant patients and those with low pretest risk factors. Take a look, and when this whole pandemic is over your quiver will be fuller of Dimer tips.

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Diagnostics: Brain MRI

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Diagnostics: Brain MRI

If you have ever nodded along as someone described an MRI series weighting, you are not alone. As this modality becomes more accessible to the Emergency Physician, it is incumbent on us to familiarize ourselves with the critical aspects and critical diagnoses of MRI and how to speak the language. Dr. Zalesky takes us on a tour of the physics, indications and low-down of MRI from the ED.

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Diagnostics: Musculoskeletal Ultrasound

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Diagnostics: Musculoskeletal Ultrasound

Ultrasound continues to push into more and more of the physical exam, and nowhere is that clearer than in the musculoskeletal exam. From diagnosing and prognosticating patellar tendon ruptures and ligamentous injuries to being a procedural adjunct in shoulder dislocation to critical identification of necrotizing fasciitis, it continues to push boundaries. Dr. Broadstock gives us a look at some of the applications you need to make yourself a better practitioner in this week’s Diagnostics of Musculoskeletal US post.

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Enter the Centor

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Enter the Centor

Strep pharyngitis, commonly known as “strep throat” is a bacterial infection of the oropharynx caused by group A beta hemolytic streptococci (GAS), specifically S. pyogenes. This infection affects more than 500,000,000 people annually worldwide per year, ultimately resulting in a significant number of doctor’s visits, including to the ED (1). The classic clinical presentation of GAS pharyngitis includes sudden onset of sore throat, fever, and odynophagia. If untreated, complications of GAS pharyngitis include scarlet fever, rheumatic heart disease, post-streptococcal glomerulonephritis and peri-tonsillar abscess.  In this post, we explore the diagnostic evaluation of pharyngitis with special attention to the use of the Centor criteria and rapid antigen testing.

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Diagnostics: Alternative EKG Leads

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Diagnostics: Alternative EKG Leads

Ever have a patient that looks more concerning than their EKG? Perhaps their ischemia is in that anatomically difficult to access right ventricle or even posterior. Join Dr. Connelly in looking at the utility of right sided, posterior and Lewis leads and bring something new to your next chest pain patient.

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The CBC and the Man Behind the Curtain

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The CBC and the Man Behind the Curtain

It’s been called “the refuge of the intellectually destitute (physician)” by Amal Muttu. The CBC is a much maligned test that is nevertheless one of the the most frequently ordered diagnostic tests in the ED. To truly know how to interpret this test, one must understand its individual components, the possible causes of variations from normal for those components, and how it integrates into the clinical presentation of the patient. Also, it can’t help but to know and understand some of the historical background…

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Diagnostic Questions of the HEART

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Diagnostic Questions of the HEART

Chest pain is a part of our everyday practice, as has become utilization of the HEART score. Successfully weathering a storm of validation, it is incumbent upon us to know the data and variability to its use in the ED. This week Dr. Hunt will take us through the diagnostic view on the HEART score and the data behind it.

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Back to Basics: Pelvic XRays

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Back to Basics: Pelvic XRays

Pelvic Xrays are a key component of trauma, fractures and dislocations seen every day in the ED, but when is the last time you went back over the anatomy and radiographic tips and tricks of the pelvic radiograph? Join Dr. Mand's thorough break down of this commonly used ED diagnostic - the Pelvic XR.

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Grand Rounds Recap 2.7.18

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Grand Rounds Recap 2.7.18

This week Dr. Carleton kicked off a lecture series on the pediatric airway by discussing some anatomic and physiologic challenges as well as predictors of difficulty. In the latest installment of our Global Health lecture series, Dr. Lagasse gave us a great review on the unique uses of point of care ultrasound in a resource limited setting. Our R1 Diagnostics curriculum was continue by Dr. Gleimer who discussed the use of PFTs in the ED setting and Drs. Ham & Wright finished things up with an altered mental status CPC presentation. 

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Interpretation of Thyroid Studies in the Emergency Department

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Interpretation of Thyroid Studies in the Emergency Department

Thyroid studies, often lying in the depths of any medical student differential, are an important tool in the Emergency Physician's toolkit, and knowing what to order when is a key part of using them wisely. This week, Dr. Makinen gives us a breakdown of thyroid pathology and testing.

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"

Since the turn of the century, lactate has become a mainstay in emergency medicine and critical care laboratories. Some clinicians may hate it, others may love it, but very few can feign apathy on the subject. The utility of lactate in the emergency department and the ICU in guiding resuscitations, predicting mortality, or identifying occult critical illness continues to be discussed in the literature, most fervently in the realm of sepsis. But what are the humble beginnings of this molecule? Most fundamentally, how is lactate generated in the setting of critical illness? And how did it come to be so firmly embedded in our understanding of the pathophysiology of critically ill patients?

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