by reuben in arrhythmia, ecg
Cardiologists use calipers. Intensivists write little marks on a page and march them across. Emergency providers fold the ECG in half and hold it up to the light. Or the sun.
Fold the tracing in half. Hold up to the light.
Now align the QRS complexes. The rhythm is regular.
Here is another example.
Irregular. Cannot line up QRS complexes.
by reuben in .headache
emergency clinicians do not rule in migraine or other benign causes of headache. unless the headache is congruent to an established pattern for that patient, the history and physical specifically targets these 13 conditions.
subarachnoid hemorrhage: family history, PCKD, known berry aneurysm, sudden and maximal intensity at onset, posterior location
intracerebral hemorrhage: trauma, coagulopathy, decreased level of consciousness, hypertension
CNS infection: fever, immunocompromise, CNS instrumentation, recent head/face infection, meningismus
increased intracranial pressure: slowly progressive, cancer history, worse in morning, worse with head in dependent position, papilledema
carbon monoxide toxicity: contacts with similar illness, locationality (worse at home or at work)
acute angle closure glaucoma: unilateral anterior location, precipitated by darkness, change in vision, red eye
temporal (giant cell) arteritis: elderly, temporal location, jaw claudication, shoulder girdle symptoms
cervical artery dissection: unilateral pain involving neck/face, trauma history
cerebral venous sinus thrombosis: thrombophilia, neurologic signs/symptoms in non-arterial distribution, eyelid edema, proptosis
hypertensive encephalopathy: altered mentation, marked hypertension, improves with antihypertensive therapy
ENT/dental infection: ear, sinus, dental findings
idiopathic intracranial hypertension: young overweight female, hormone use, vision changes
preeclampsia: late pregnancy or postpartum
by reuben in .GI bleed, .trauma-general, resus