Differentiating Severity in Pulmonary Embolism Cases
Pulmonary embolism is not one disease. It is a spectrum. At one end: the incidental, asymptomatic PE found on imaging done for another reason. At the other: the crashing patient with obstructive shock, severe RV failure, and cardiac arrest. The challenge in the ER is everything in between. The 2026 AHA/ACC multisociety acute PE guideline […]
The Real Causes of ER Crowding and Their Solutions
I’ve worked long enough in emergency medicine to tell you this with complete confidence: we often talk about crowding as if it were a waiting-room problem, a triage problem, or a problem caused by too many “non-urgent” patients. It isn’t. That is the visible surface of crowding, not the pathology underneath it. The real problem […]
Effective ED Management of Pulmonary Embolism
A practical, evidence-based, physiology-first ED approach — and the pitfalls to avoid In the emergency department, PE is one of the classic traps.Miss it, and the patient can deteriorate fast.Overcall it, and you expose people to unnecessary CT, contrast, radiation, false positives, and treatment they never needed. The 2026 AHA/ACC multisociety guideline pushes a very […]
Understanding Polymorphic VT: Key Differences and Management
The key question is not “Is the QRS changing?” The key question is: Is the QT interval prolonged or not? That single distinction changes the physiology, the cause, and the treatment. Polymorphic VT in one sentence Polymorphic VT is a ventricular tachycardia with beat-to-beat variation in QRS shape, and it is always treated as an […]
Effective Pad Placement for Cardiac Arrest
In cardiac arrest, pad placement matters. But not because one position is clearly superior. It matters because good placement helps the shock reach the heart. That is the goal. You need enough current to pass through the myocardium and stop VF or pulseless VT. First principle: do not overcomplicate pad placement What does the evidence […]
The Perfusion Gap: Why “Good” Teams Fail at CPR (And How to Fix It)
By Abdolghader Pakniyat, peer reviewed by Sabrina Berdouk 1. Introduction: The Perfection Paradox In the sterile, controlled environment of a certification course, every clinician can recite the ACLS algorithm with surgical precision. However, when the doors of the Emergency Department swing open and a “code blue” becomes a chaotic reality, that theoretical knowledge often collides […]
Integrating POCUS into CPR: Ultrasound-Guided Decision Pathways (Part 3)
By Abdolghader Pakniyat (Reviewed by Dr. Sabrina Berdouk ) Educational content only. Follow your local AHA/ERC guidelines and institutional protocols. POCUS is operator-dependent. By Part 3, the question is no longer whether ultrasound has a role in cardiac arrest.The real question is simpler and harder: What should POCUS actually change? Not every finding deserves an […]
Surviving the Surge: A Physician’s Manual for the Mass Casualty Incident
By Abdolghader Pakniyat, Reviewed by DR. Sabrina Berdouk The Scenario: The “City Center Collapse” 14:00: You are the attending physician on duty. Dispatch reports a partial collapse of a stadium during a high-profile event. Expected casualties: 150+. Your hospital is 4 kilometers from the scene. In this moment, the standard of care shifts. You are […]
POCUS Misinterpretations in CPR: Key Insights
(Part 2 of the POCUS in CPR & Critical Care series) By Abdolghader Pakniyat (Reviewed by Dr. Sabrina Berdouk) Educational content only. Follow your local AHA/ERC guidelines and institutional protocols. POCUS is operator-dependent. POCUS can clarify uncertainty during cardiac arrest.It can also mislead teams into false confidence. Most harm from ultrasound in CPR does not […]
Integrating POCUS into CPR(Part 1) | Keeping Pauses Short
By Abdolghader Pakniyat (Reviewed by Dr. Sabrina Berdouk) Educational content only. Follow your local AHA/ERC guidelines and institutional protocols. POCUS is operator-dependent. This is Part 1 of a series on POCUS in CPR and critical care. POCUS can help during cardiac arrest.It can also harm patients if it prolongs pauses in chest compressions. A high-quality […]