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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. Clinical impact: The patient’s DVT ultrasounds were negative.

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SAEM Clinical Images Series: Pediatric Neck Mass

ALiEM

Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM; American Thyroid Association Task Force on Thyroid Hormone Replacement. The patient had no significant past medical history. She also endorsed three weeks of cough and congestion, and one day of muffled voice. Pediatr Rev.

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High sensitivity cardiac troponins for ED chest pain evaluation (2022 ACC pathway)

ALiEM

Low-risk patients do not routinely require stress testing in the ED. Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. That’s because these values are assay specific. She does not smoke.

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Hemolytic Uremic Syndrome (HUS): Rebaked Morsel

Pediatric EM Morsels

A thorough review of vital signs, physical exam findings and a complete blood count with differential, renal function panel and urinalysis offer valuable information in the patient being worked up for HUS. Hemolytic Uremic Syndrome: Presentation The diarrhea associated with typical HUS may be bloody or watery.

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Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

What would you do at this time with this information? But pain is an important signal in MI and informs the clinician of the urgency. Smith : As Willy states, ACS with persistent symptoms is a guideline recommended indication for <2 hour angio (both ACC/AHA and ESC). So I would be worried about inferior OMI. At midnight.

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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

If this EKG were handed to you to screen from triage without any clinical information, what would you think? showed that , when T-waves are inverted in precordial leads, if they are also inverted in lead III and V1, then pulmonary embolism is far more likely than ACS. looked at consecutive patients with PE, ACS, or neither.

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Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

Dr. Smith's ECG Blog

ACS would be highly unusual in a young athlete, and given the information on his race bib, one must first suspect that the abnormal ST elevation is due to demand ischemia, not ACS. His initial ECG is shown here. A bedside echo performed by the emergency physician showed no wall motion abnormality and confirmed LVH.

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