Background: The estimated total annual cost of syncope-related hospitalizations in the year 2005 was about $2.4 billion with a mean cost of $5,400 per hospitalization. Syncope of cardiac etiology has 18-33% mortality in comparison to 0-12% with non-cardiac etiology. We sought to evaluate the role cardiac biomarkers in patients presenting with syncope to evaluate their [...]

Background: Chest pain and related symptoms are the number two reason patients visit emergency departments in the United States, often leading to routine hospitalization or observation. Improving utilization management of patients presenting to the emergency department with chest pain is an important goal for hospitals. Use of 5th generation troponins and risk stratifying tools can [...]

Background: Troponin is a big molecule, with its fragments not readily cleared by impaired renal function or during dialysis [1]. Oftentimes diagnosing myocardial injury/infarction (MI) is challenging in patients with ESRD due to atypical clinical features coupled with indeterminate ECG changes [2], and elevation of troponin levels with lower PPV [3]. In this study, we [...]

Case Presentation: A 44-year-old Nigerian woman with no medical history and recent travel to Mexico presents with cough for 4 weeks, fever, and malaise. She initially presented to urgent care with respiratory complaints, was diagnosed with pneumonia and given azithromycin. Her symptoms did not improve and she went to the ED. Vitals were notable for [...]

Case Presentation: A 62-year-old Caucasian male presented to the hospital with complaints of fever, cough for 1 week. The patient was diaphoretic and also complained of malaise. He was admitted after a failed course of oral antibiotics due to suspected pneumonia. The patient denied any chest pain, dyspnea, or sputum production with the cough. Physical [...]

Case Presentation: 72-year-old male with h/o HTN, DM, obesity, polymyalgia rheumatica (on steroids), CKD stage IV, ankylosing spondylitis, and HFrEF (LVEF 45-50%) underwent total knee arthroplasty with removal of prior implant and distal femur replacement for osteosarcoma. Cut to close time was 9 hours. Intraoperatively, the SBP dipped to 90s for about 10-15 minutes after [...]

Background: Chest pain is a common chief complaint among adult patients presenting to emergency departments. An assessment of chest pain management at the institution noted significant variability in provider treatment patterns for chest pain. While a NSTE-ACS protocol existed, there was varied use and inconsistent adoption. Review of pre-intervention data demonstrated that some emergency medicine [...]