Thursday, 3 October 2013

The Chart Review has Moved!

Dear Blogger,

It's been swell. Thanks for the memories. But...

Thanks to some handy work and kindness from Dr Mike Cadogan at, The Chart Review has migrated to WordPress.

New URL for The Chart Review is
New look.
Very soon, new cases and posts.

Please update your email subscription and RSS feeds.


Tuesday, 23 July 2013

Cough, Syncope and Pericardial Effusion

A 60yM with a history of lung cancer is brought to your ED. He complaints of worsening shortness of breath, cough and new episodes of syncope. Over the past 12 hours he has syncopized 4 times, all associated with coughing. Prior to his presentation, he has never had a syncopal episode.

Monday, 10 June 2013

Scareway Case #2 - Blood, Vomit, MILS; with Yen and Minh

An hour into your morning shift at your community hospital, Canadian Janus General, 50yF is brought to your ED by paramedics. She was involved in a head-on MVC with a large truck that crossed over into oncoming traffic.

Monday, 3 June 2013

Canadian Janus General

Hi folks,

Been a while since I posted anything - sorry for the slow productivity...
This is a mini post.

Recently Scott Weingart of the EMCrit podcast had an episode on his new home hospital, Janus General. This is a virtual hospital inspired by the folks at St Emlyn's, a virtual hospital and blog site situation in the UK.

Why a virtual hospital? Because it allows you to retain patient confidentiality to a greater degree, and it allows flexibility with what your "hospital" provides.

Janus isn't the right fit for me, since I'm Canadian trained/insured/etc and we have a different level of litigation where I'm from. However, with Scott's blessing, I've opened a Canadian partner site to Janus. As of this post, unless otherwise stated, all cases presented on the Chart Review will Canadian Janus General hospital. Canadian Janus is a community ED in Canada, with Canadian policies. The goal is to provide a Canadian slant to emergency medicine and healthcare. We transfer out major traumas, STEMIs and neurosurgical cases.

If you wish to situate your cases at Canadian Janus General, feel free.

New post coming soon!

Friday, 3 May 2013

A clear-cut case of acute coronary syndrome (?)

Your shift is running smoothly. You’ve been applying all the fantastic FOAMed (what’s FOAM/FOAMed?) you learned this week and life couldn’t be better.  You pick up the next chart: a 50yF sent by her family doc to the ED - she presented to his office a few hours after a 10 minute syncopal episode at home preceded by chest pain. The note says: Please rule out cardiac ischemia.

She’s obese and has a history of diet-controlled DM. She’s never syncopized before and doesn’t recall previous episodes of chest pain. The event happened in the morning – 15-20 minutes of squeezing epigastric pain/pressure, followed by presyncope, followed by syncope. She hit her head and has a small lac over the eyebrow. Since the episode she’s felt generally unwell and so proceeded to see her FD.

On exam, vitals are a temp of 36, pulse 104 and regular, BP 140/90 at triage and then approximately 170/110 (all 4 limbs), RR 20, sat 94-96%. Normal glucose. She’s obese. She’s a bit anxious but otherwise in no distress, looks well. Breathing is not laboured. Her CVS exam is unremarkable, lungs clear and no edema.

The ECG, already done, is on her chart and this is what you see.

Thursday, 14 March 2013

Acute Pulmonary Edema - Nitro vs Lasix?

A 75yF presents to your ED acutely short of breath. Two hours prior to ED arrival, she became suddenly short of breath. Her family tried administering her salbutamol (Ventolin) to no avail. She was driven to the ED. Her PHx includes hypertension and asthma, the former poorly controlled recently despite amlodopine, HCTZ and ramipril. She denies chest pain, N/V or diaphoresis. She had a minor surgical procedure a few days prior.

At triage her vitals included a RR of 45, pulse 100 and O2 sat 70%. BP is unobtainable. She is rushed to your resuscitation area. Her exam reveals an alert and oriented woman in extemis who is able to speak 1-2 word sentences with a lot of accessory muscle use. On a NRB mask she manages an O2 sat of 94%. The lack of BP makes you worry about a large PE with hypotension. The nurses try again. Her JVP cannot be seen. There are diffuse crackles to the scapulae and wheezes bilaterally. Heart sounds are normal and regular without murmurs. There is no peripheral edema or leg swelling. The BP finally registers – 280/150!

Tuesday, 19 February 2013

2 Difficult Cases to Swallow

A fairly frequent presentation to the ED is that of difficulty swallowing. By true definition this is “dysphagia” although commonly physicians and physicians-in-training use this word interchangeably with “odynophagia” (painful swallowing). Here are two interesting and unusual cases of dysphagia seen in the ED.