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Blu Man
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Is the Patient Sober? Clinical Sobriety versus Blood Alcohol Concentration
There is significant practice variability when providers are asked to determine if a patient is intoxicated. Some providers will evaluate a patient to determine if a patient is “clinically sober”, while other providers will rely on a patient’s blood alcohol...

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Uncomplicated Urinary Tract Infection in Older Adults: Diagnosis and Treatment
It seems like a simple enough question: How do you diagnose and treat uncomplicated UTIs in older adults? The answer is: It depends. Part 1 of this post will discuss diagnosis of UTIs in this population, and part 2 will address treatment. UTIs are the most ...

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Is it time to trash the stethoscope? The age of ultrasound
IS THE PHYSICAL EXAM A RELIC OF THE PAST, BECAUSE OUR TOOLS ARE RELICS OF A PRIOR ERA? It is important to do and teach a thorough physical exam. I cautioned against the overreliance on diagnostic testing in lieu of a physical exam, which can be initially bu...

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Lactic Acidosis and Beta Agonist Therapy in Asthma
A 45 y/o male with moderate persistent asthma presents with wheezing and cough following a viral URI . He is tachypneic and has diffuse wheezing. PEFR is 250 (>50% below his normal). Initial ABG is 7.46/33/70 on room air with a lactate of 2.0 mmol/L. He rec...

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Cyclobenzaprine vs TCA Toxicity
Should we treat a cyclobenzaprine (Flexeril) overdose similar to a tricyclic antidepressant (TCA) overdose?  With the only difference between the commonly prescribed muscle relaxant, cyclobenzaprine, and the TCA amitriptyline consisting of a single double b...

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When the PERC Rule Fails
Kline et al developed a clinical decision tool based on parameters that could be obtained from a brie f initial assessment to reasonably exclude the diagnosis of pulmonary embolism (PE) without the use of D-dimer in order to prevent unnecessary cost and the...

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Trick of the Trade: Urine pregnancy test without urine
  A 25 year old woman presents to the Emergency Department having syncopized in the waiting room, where she was triaged with the chief complaint of abdominal pain. Ectopic pregnancy immediately bubbles to the top of your differential diagnosis. The patient ...

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New Year’s Resolution: Let’s Dose Vancomycin Correctly in the ED
Vancomycin remains one of our workhorse antimicrobials for treating infections caused by methicillin-resistant  S. aureus  (MRSA). As the incidence of MRSA infections continues to rise  AND  we are st arting to see   , it is paramount that we optimize its u...

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Applying to EM-Critical Care Medicine Fellowships: What you need to know
Emergency physicians (EPs) have been successfully training in and practicing critical care in the ICU for decades, though until recently board certification remained closed to EPs. In the last few years,  however, we have seen monumental changes in training...

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While the rate of diabetes climbs, the number of patients who are using insulin pumps grows apace.  Pumps appeal to physicians because they mimic normal insulin physiology with a consistent basal rate and appropriate bolus doses for meals. This leads to tig...
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