Wide Complex Tachycardia

Intro

There’s an old adage that wide complex tachycardia is VTach until proven otherwise. While this is true as do not want to miss any potentially lethal arrhythmia, it is also important to understand the differential for wide complex tachycardias so that we can tailor our potential treatments to the specific arrhythmia. It is also important to note that in any unstable patient with a wide complex tachycardia (or narrow complex tachycardia) that electricity is always safe.

Narrow Complex Tachycardias

Intro

The differential for narrow complex tachycardia is extremely important as it is the most commonly seen abnormal EKG in the emergency department. It includes rhythms such as sinus tachycardia, AVnRT, AVRT, atrial flutter, ectopic atrial tachycardia (EAT), atrial fibrillation, atrial flutter, and multifocal atrial tachycardia (MAT).

The goal of this blog is to run through this differential and give some methods to differentiate the rhythms. Although we will not delve too deep into antiarrhythmics, it is important to note that electricity is safe in all unstable rhythms no matter the etiology.

Pediatric Urologic Emergencies

In this blog, we’re going to dive into the topic of  pediatric urologic emergencies. We’re going to focus on some of the more uncommon emergencies such as:  phimosis, paraphimosis, priapism, entrapment injuries, testicular torsion, epididymitis, varicocele, and hydrocele. It’s important to note that UTI’s and Kidney stones are also common in peds, and often require additional work-up as often indicate abnormal anatomy or disease processes.

The Limping Child

Background

Most children begin walking between 12 and 18 months. Their initial gait starts broad-based, often with short asymmetric steps. At faster speeds, they often develop foot slapping and asymmetric arm swinging. By ages 3-5 years-old, children start to walk with more fluidity and symmetric strides. By ages 5-7 years-old, their gait begins to resemble the same pattern as an adult.

Bleeding AV Access

Bleeding AV Access

Background

  • Most often occurs at dialysis center after fistula site is accessed
  • Presents as punctate bleed overlying fistula. Can be slow oozing bleed from uremia or high-pressure bleed similar to arterial bleed
    • Slow oozing bleed is less common in ED as hemostasis is often achieved at dialysis center

Journal: PECARN Head CT Rule

PECARN Head CT Rule

Dr. Brian Yu did a great 5-minute summary on the PECARN head CT Rule that was published in 2009. It’s an ambitious study that involved 25 emergency departments and included 42,412 patients under the age of 18 years who presented with blunt head trauma. It further risk stratified these patients into 2 major cohorts of <2 years of age and 2-18 years of age. It excluded patients with trivial injury, penetrating trauma, neurologic history, and those with prior imaging. The outcomes this study aimed for were clinically important findings including death, need for neurosurgical intervention, intubation >24 hours, and admission >2 nights. 

EKG: Pericarditis vs. STEMI

Dr. Patwari did a great review on differentiating ST elevations associated with pericarditis vs. acute MI. From medical school, I think we can recall many of the classic EKG findings that support pericarditis Diffuse ST elevations Concave upwards STE PR depressions in multiple leads (only reliable seen in viral pericarditis) PR elevation in aVR However,

Bioterrorism

Dr. Somy Thottathil did an awesome lecture on bioterrorism this past week. And although it is hopefully something we never have to see, as one of the major hospitals designated as a bioterrorism site in Chicago, it is something that we should be prepared to recognize and treat. It’s also good review for all the med school knowledge we haven’t needed (thankfully) for some time now. The main topics we’ll focus on are the Category A agents:  Botulism, Plague, Anthrax, Smallpox, and Viral Hemorrhagic Fevers (which includes Ebola, Marburg, Lassa Fever, and Crimean-Congo Hemorrhagic Fever). We are only going to discuss Ebola as current outbreaks are still occurring.

Thyroid Emergencies

Thyroid emergencies are an interesting class of disorders. They’re rare, but are an acute, life-threatening group of syndromes. This is in contrast to the vast majority of thyroid cases that often present with minor symptoms (or found on routine labs), only requiring outpatient treatment and medications. Thyroid emergencies are the extreme versions of these thyroid disorders.  They fall into two categories:  “too low” of thyroid hormone (myxedema coma) and “too high” of thyroid hormone (thyroid storm). The post starts with some background anatomy and physiology, and then dives into each disorder separately. Also briefly discusses Levothyroxine overdose.