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September Introduction

Jan Shoenberger, MD and Stuart Swadron, MD, FRCPC
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17:00
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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05:41

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EM:RAP 2019 September Written Summary 465 KB - PDF

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prestwig1 -

What happened to the 20-year-old patient? Was it simple SVT or something more ominous?

Stuart S., MD FAAEM -

Sadly, I have little in the way of follow up. He was discharged the following day on beta blockers but there has been no subsequent activity in the record. It may well have been an SVT - but not so simple in my humble opinion!

Joe J. -

What about the link to the ATLS article? I cannot find it.

Jan S. -

Here you go! http://bulletin.facs.org/2018/06/atls-10th-edition-offers-new-insights-into-managing-trauma-patients/

James P. -

In the rant against stress testing, is he talking about only "low risk patients" (ie. HEART score of 3 or less) or any patient that has a negative two troponin workup in the ED. In my place we have no support for chest pain and it's a binary discharge home or ED obs for stress test in AM. Moderate or high risk end up getting a stress because we have nothing else to offer.

I just did this 3 days ago and the patient's stress (cardiac PET perfusion) was positive and he just got a CABG. He realistically could have been called "low risk" because he was 70 without risk factors. I called him "moderate risk" because his chest pain was concerning enough to make him a HEART score of 4 which convinced me to stress him. Should we send these home? Is this CABG potentially not beneficial based on the evidence?

Sorry didn't know where else to put this. Very interesting piece and I believe that in general stress testing doesn't help but it takes some of the burden off of us sending moderate to high risk patients home even if it doesn't actually provide survival benefit.

Jon M. -

Interesting discussion on the end about personal protection devices and concealed carry in the ED. As administrators and health care systems continue to decrease security shifts and take away scanners (because it's not good for the patient experience) I wonder if subjects like this will become more commonplace in years to come. Not sure what the right answer is.

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EM:RAP 2019 September Full episode audio for MD edition 228:36 min - 247 MB - M4AEM:RAP 2019 September German Edition Deutsche 113:47 min - 156 MB - MP3EM:RAP 2019 September Farsi Edition Farsi 199:37 min - 274 MB - MP3EM:RAP 2019 September Spanish Edition Español 81:07 min - 111 MB - MP3EM:RAP 2019 September Canadian Edition Canadian 19:03 min - 26 MB - MP3EM:RAP 2019 September French Edition Français 20:28 min - 28 MB - MP3EMRAP 2019 September Board Review Answers 135 KB - PDFEMRAP 2019 September Board Review Questions 710 KB - PDFEM:RAP 2019 September MP3 Files 295 MB - ZIPEM:RAP 2019 September Written Summary 465 KB - PDF

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