Doctors Can’t Remember Everything: Calciphylaxis and a Diagnostic Aid

In Featured by Michael GarfinkleLeave a Comment

The general approach to the differential diagnosis has remained unchanged since the dawn of modern medicine. A doctor sees a patient, gets some initial information, and then creates a list of what they think are the most likely and dangerous possibilities. This list of possibilities is created by comparing the present patient to others that the doctor has seen and/or querying his/her memory for disease patterns that they have read in textbooks. This …

Boring Question: What is the risk of Contrast-Induced Nephropathy?

In Clinical Questions by Michael Garfinkle3 Comments

I once encountered a patient who was empirically started on warfarin therapy after a presumed diagnosis of pulmonary embolus. The treating team did not want to risk an AKI by performing a CT-PE as the patient’s creatinine was 120 and a V/Q scan was not an option due to underlying lung disease. This made me uncomfortable. There’s a known risk of hemorrhagic stroke (~0.5% per year) and other major bleeding events with warfarin, …

View Post

Boring Question | Do patients with liver disease need FFP before procedures?

In Clinical Questions by Michael Garfinkle1 Comment

I was recently asked to give fresh frozen plasma to a patient with liver disease and an elevated INR before a therapeutic thoracentesis. He was otherwise healthy and had no history of bleeding diathesis. While I was asking for consent and explaining the risks and benefits of blood product transfusion, I began to wonder about the true benefits in his case. Knowing that liver failure leads to both pro and anti-coagulant deficiencies, I wondered: Is an elevated …

View Post

How to Use Likelihood Ratios in Every Day Practice

In Knowledge Translation by Michael Garfinkle5 Comments

A large part of an emergency physician’s job is finding and ruling out emergencies. To do that we ask the patient questions, examine them, look at their blood, and take radiographic images. The goal of all of these tests is to rule-in or rule-out disease. However, not all tests are created equal… As a student, I became frustrated when I was told that such-and-such test was “good” and I should use it. What did good …