Background: While use of technologies such as ultrasound and electrocardiographic (EKG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the setting, experience or practice of providers that use these tools. Methods: Using data from the PICC1 survey of vascular access specialists, we identified technology-users from non-users. We defined [...]

Background: The position of the tip of a peripherally inserted central catheter (PICC) is associated with deep vein thrombosis (DVT). Optimal position of the tip is the cavoatrial junction; more proximal tip positions are associated with greater risk of DVT. EKG-guidance has recently emerged as a modality to ensure proper tip position. Compared to chest [...]

Case Presentation: A 73 year-old female with a history of recurrent DVT’s on Warfarin, microscopic polyangiitis and ulcerative colitis status post total colectomy initially presented with altered mental status. Lab workup revealed acute renal failure for which she underwent intermittent hemodialysis. Due to a suspicion for microscopic polyangiitis relapse, the patient was started on steroids. [...]

Background: It is common practice to monitor QTc interval in hospitalized patients newly started on antipsychotics. While some guidelines exist for frequency of ordering EKGs in the outpatient setting, these may not apply to inpatients due to comorbid electrolyte disturbances or addition of other new medications. There are no evidence-based guidelines for QTc monitoring frequency [...]

Background: Antipsychotics can prolong QTc interval and lead to development of the fatal arrhythmia Torsade de Pointes. Accordingly, serial EKG monitoring of QTc in patients newly started on antipsychotics has become common practice in hospitals. By current standards, medical management of antipsychotic therapy is clinically indicated when QTc > 500ms and/or there is an increase [...]

Case Presentation: A 53-year-old male with a past medical history of alcohol abuse presented to the emergency department after a presyncopal episode following new onset of hematemesis and black, tarry stools. He additionally had sharp, bilateral chest pain that was present at rest with no radiation or worsening with exertion. Upon presentation he was hypotensive, [...]

Case Presentation: A 19-year-old male with no known medical history presented to the ED after being found down and profusely diaphoretic by his parents. He was unresponsive to multiple doses of Ativan and Narcan. He was tachycardic to the 150s and had respiratory insufficiency, so he was intubated in the ED. Initial EKG showed sinus [...]