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Digest of Dr. Herbert's Monthly Audio CME Series: Septic Patients & Urethral Injuries
by Mel Herbert, MD on September 30, 2008
Dr. Al Sacchetti weighs in on the issue of etomidate in sepsis and reviews his recent debate with Dr. Ron Walls in the July issue of annals of emergency medicine. Here’s a highlight. A single dose of etomidate will eliminate the adrenal gland’s response to ACTH by inhibition of 11-ß-hydroxylase leading to a depressed cortisol response.
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Digest of Dr. Herbert's Monthly Audio CME Series: Aortic Dissection, Spinal Cord Injuries & Traumatic Brain Injuries
by Mel Herbert, MD on August 31, 2008
Aortic dissection is a difficult diagnosis to make and has been dubbed the “Great Masquerader” due to the myriad of possible presentations including stroke, MI, abdominal pain, and lower extremity problems. D-dimer may be useful as a screening test for dissection because of reported sensitivities of >99% and negative predictive values >99% across multiple studies.
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Digest of Dr. Herbert's Monthly Audio CME Series: Myths in EM
by Mel Herbert, MD on July 31, 2008
A digest of Mel Herbert’s monthly audio CME series
edited by Chris Feier, MD
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Digest of Dr. Herbert's Monthly Audio CME Series: Sepsis Update
by Mel Herbert, MD on June 30, 2008
A digest of Mel Herbert's monthly audio CME series
edited by Chris Feier, MD
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Digest of Dr. Herbert's Monthly Audio CME Series: Pelvic Fracture, Encephalopathy Management & Infant Analgesis
by Mel Herbert, MD on May 31, 2008
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A digest of Dr. Herbert’s monthly audio CME series
edited by Chris Feier, MD
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Digest of Dr. Herbert's Monthly Audio CME Series: Ectopic Pregnancy,
by Mel Herbert, MD on April 30, 2008
A digest of Dr. Herbert’s monthly audio CME series
edited by Chris Feier, MD
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Digest of Dr. Herbert's Monthly Audio CME Series: Dyspepsia & Thrombolytics
by Mel Herbert, MD on March 31, 2008
A digest of Dr. Herbert’s monthly audio CME series
edited by Chris Feier, MD
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Digest of Dr. Herbert's Monthly Audio CME Series: "Bullet Proof" Chart & Pancreatitis
by Mel Herbert, MD on February 29, 2008
A digest of Dr. Herbert’s monthly audio CME series
edited by Chris Feier, MD
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Digest of Dr. Herbert's Monthly Audio CME Series: ACS Risk Stratification
by Mel Herbert, MD on January 31, 2008
A digest of Dr. Herbert’s monthly audio CME series, edited by Chris Feier, MD

As emergency physicians we want to stratify patients into risk categories based on their short-term probability of death or adverse event. This is in contrast to the internist who wants a more global assessment of a patient’s health to determine long-term preventive medications, such as statins. There are many tools we can use for this, but one of the most powerful is the resting EKG.

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Using the Perc Rule
by Mel Herbert, MD on December 31, 2007
1.Use of the PERC (Pulmonary Embolism Rule-out Criteria) rule can significantly decrease work-up for pulmonary embolism.
To apply this rule, the clinician must first use clinical gestalt to classify the patient as low risk. The PERC rule, which consists of eight clinical criteria including history, physical and vital signs, can then be used. If both of these criteria are met, then there is less than a 2 percent risk that this patient has a PE and no further work-up is needed.
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