Stroke/TIA Mimics .... US Better Than Cardiologists

Two great articles from ACEP news. Well worth the read, especially in this day and age where we all fear the infamous "Stroke Code," a great discussion on mimickers of Stroke/TIA - most commonly being Complicated Migraine and Partial Seizure. I assure you after the article you will be more confident differentiating the bogus neuro symptoms and complaints we see ALL THE TIME, versus serious stuff we need to work up.

Stroke Mimic Article 


The next article is a summary of a cool study showing the uselessness of cardiologists -- haha just kidding. But seriously, a simple and quick bedside US Echo outperformed the cardiologists physical exam:  "Ultrasound had a far higher correct-diagnosis rate than did cardiologists’ physical exam for nearly all of the heart conditions the cardiologists encountered."

Check out the report here:

US vs Cardiologist Physical Exam Article

WINNERS: Ultrasound Competition MARCH 2013

Thanks to all who submitted.  The winner is:

MAYA LIN    -->  Maya's images below

Submission: DVT/PE  with Right Ventricular strain and classic D sign. This is a sign of Acute PE. You must however in the acute setting have some evidence differentiating RV strain of a chronic etiology to the acute etiology (PE or other mechanical RV outflow tract obstruction).

D Sign: This is a sign in which the LV appears like the letter D due to paradoxical leftward movement of the interventricular septum during LV relaxation.

Taken from an excellent article on Ultrasound of the Right Ventricle in Critical Illness

There are other ways to assess for acute PE in the setting of cardio-respiratory arrest including the McConnell sign , or apical RV contraction with a kinesis of RV free wall, plump IVC with no respiratory variation, RV/LV size ratio >1:1.

More Resources:

http://www.slideshare.net/basselericsoussi/thoracic-ultrasound-for-diagnosing-pulmonary-embolism

http://emoryeus.blogspot.com/2012/04/mcconnells-sign-and-acute-pe.html

Transvenous Pacer Placement

Thanks to a scary, but interesting recent case in our ED. The following is a helpful video to remind us all how to place this a temporary transvenous pacer.

Either here, in a formal dictated video:
http://www.youtube.com/watch?v=5BiQQYjw6no

Or here, in an actual clinical scenario: