Sixty-four-slice multidetector computed tomography: the future of ED cardiac care

Multidetector computed tomography (MDCT) imaging, a technological advance over traditional CT, is a promising possible alternative to cardiac catheterization for evaluating patients with chest pain in the emergency department (ED). In comparison with traditional CT, MDCT offers increased spatial and temporal resolution that allows reliable visualization of the coronary arteries. In addition, a triple scan, which includes evaluation for pulmonary embolism and thoracic aortic dissection, can be incorporated into a single study. This test will enable emergency physicians to rapidly evaluate patients for life-threatening illnesses and may allow safer and earlier discharges of many patients with chest pain in comparison with a traditional rule-out protocol. In this article, we will highlight the technological advances of MDCT imaging, review the literature on coronary angiography via MDCT, and discuss the future of this technology as it relates to the ED

Myopericarditis diagnosed by a 64-slice coronary CT angiography "triple rule out" protocol

We report a case of myopericarditis in a 30-year-old male complaining of shortness of breath. In an emergency department (ED) setting, the symptoms of myopericarditis may overlap with many disease entities and can be a challenging diagnosis to make. However, with the use of a 64-section coronary CT angiography in a “triple rule out” (TRO) protocol, we were able to detect a large pericardial effusion surrounding the heart and moderate global hypokinesis in the setting of normal-sized heart chambers and normal coronary arteries. We were further able to exclude pulmonary embolism and thoracic dissection. This is the first reported case of diagnosing myopericarditis using a TRO protocol. It demonstrates the usefulness of TRO in making an emergent diagnosis of myopericarditis while excluding other life-threatening diseases that can lead to earlier appropriate ED disposition and care

What I learned in medical school: personal stories of young doctors

Like many an exclusive club, the medical profession subjects its prospective members to rigorous indoctrination: medical students are overloaded with work, deprived of sleep and normal human contact, drilled and tested and scheduled down to the last minute. Difficult as the regimen may be, for those who don't fit the traditional mold - white, male, middle-to-upper class, and heterosexual - medical school can be that much more harrowing. This riveting book tells the tales of a new generation of medical students - students whose varied backgrounds are far from traditional. Their stories will forever alter the way we see tomorrow's doctors. In these pages, a black teenage mother overcomes seemingly insurmountable odds, an observant Muslim dons the hijab during training, an alcoholic hides her addiction. We hear the stories of an Asian refugee, a Mexican immigrant, a closeted Christian, an oversized woman - these once unlikely students are among those who describe their medical school experiences with uncommon candor, giving a close-up look at the inflexible curriculum, the pervasive competitive culture, and the daunting obstacles that come with being "different" in medical school. Their tales of courage are by turns poignant, amusing, eye-opening - and altogether unforgettable