The HINTS exam is a 3-part test designed by Dr. Newman-Toker to clinically exclude a central cause of acute vertigo in patients who present with vertiginous symptoms. HINTS involves most famously, the head impulse test(see diagram below), a maneuver which involves torquing your patients head from midline to 20 degrees of rotation(or Vice Versa) and […]
“The Adventure of the Missing Three-Quarter”
Since Hector Pope published his now infamous study in the April 2000 NEJM, Emergency Physicians ability to clinically differentiate ACS has been called into question(10). Despite the fact the study’s findings that ED physicians missed an almost flawless 0.18% of chest pain patients who went on to be diagnosed with a MI, we have been […]
The Man with the Twisted Lip
As an Emergency Medicine doctor we are trained to function in varying degrees of uncertainty. We work in a world of risk of benefits vs harms. When the benefit to harm ratio reaches a threshold for action we are taught to do so swiftly and decisively. Given this, […]
The Adventure of the Three Students
There are few things that make emergency medicine nerds more excited than decision rules. So when the Canadian gods of decision instruments, Jeff Perry and Ian Stiell, published the results from the validation cohort of their recently derived SAH decision rules they of course had our full attention. On September 25th 2013 JAMA published this […]
The Sign of Four Part 2
On September 9th 2013 the article we have all been eagerly awaiting (or perhaps just myself!), was published in Circulation by Sarode et al (1). What was formerly known as Trial 3002 was officially named “Efficacy and Safety of a 4-factor Prothrombin Complex Concentrate in Patients on Vitamin K Antagonists Presenting with Major Bleeding”. Surprisingly […]