Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


EKG Masterclass

Sean Fox, MD

  • Hyperkalemia
    • Peaked T-waves are narrow and symmetric.
    • Wide and irregular QRS morphology.
    • Strongly consider when QRS duration greater than 200 ms.
    • Give calcium early on in the management course.
  • Wellen's Sign
    • Classically, deep symmetric T wave in V1-4.
    • Less commonly, ST elevation with biphasic T wave in V2-3.
    • Highly specific for proximal LAD occlusion.

Aortic Dissection

Erin Noste, MD

  • Aortic dissection is a "chest pain and ______ syndrome", think about the diagnosis when you have a patient who presents with chest pain and: headache, back pain, abdominal pain, syncope, neuro symptoms, renal failure, leg pain, or arm pain
  • Think dissection when patients present with sudden and severe pain, 84.8% of patients in the IRAD study presented with abrupt onset of pain and 90.6% of patients presented with severe pain
  • Check and document bilateral pulses (carotid, radial, femoral, DP, PT), even though 15.1% of patients in IRAD had a documented pulse deficit
  • When dissection is highly suspicious or diagnosed treat hypertensive patients aggressively, consider treating before sending for imaging. Goal SBP 100-120 mmHg and HR < 60 bpm. Treat first with a beta blocker (esmolol), then, if needed add a vasodilator such as nitroprusside

Hagan P. et al. The International Registry of Acute Aortic Dissection (IRAD). JAMA. 2000;283:897-903

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Michael Koehler, MD

  • SBP is the most common bacterial infection in patients with cirrhosis
  • Suspect SBP in a patient with known ascites who presents with any abdominal discomfort, worsening ascites, encephalopathy, or ileus
  • Fever is present in only half of SBP cases
  • A diagnostic peritoneal tap is a quick and easy procedure with rare complications
  • First-line treatment for SBP is 2g of cefotaxime IV
  • Renal failure is the largest predictor of mortality in SBP
  • Strongly consider giving your SBP patient 1.5g/kg of albumin IV, as it has been shown to decrease renal failure and mortality in patients admitted with SBP
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