I had several discussions in ED regarding blood transfusion in anemic patients. My argument is that if patient does not have any acute symptoms (SOB, feeling faint, tachycardia, Cardiac ischemia, …), there is no need to emergently
We are usually observing patients in emergency department in length due to biphasic reaction. There are 2 articles published during last 6 months and they emphasized regarding of how common is biphasic reaction and mortality of this reaction!
This is an old study by Annals of EM, The Role of Cardiac Risk Factor Burden in Diagnosing Acute Coronary Syndromes in the Emergency Department Setting, Feb 2007. Of 10,806 eligible patients, 871 (8.1%) had acute
NEJM published a study regarding appropriate MAP among patients with septic shock. Originally MAP of 65 was a target but the Surviving Sepsis Campaign guideline was recommending patients with HTN, may have benefit for higher
ACEP published Clinical Policy on Procedural Sedation and Analgesia in the Emergency Department in Feb 2014. as usual critical questions and very useful answers. Let’s review them:
This is a challenging question that always comes up in patients with food bolus. What evidence do we have to recommend Glucagon in this situation? is this another version of Kayexalate in case of hyperkalemia? 😉
From OHSU, Portland, Oregon study came out in Journal of Trauma and Acute Care Surgery in Dec 2013. The main idea was that INR should not guide to transfuse FFP in stable trauma patient.
After long wait! for JNC 8, it came online on Dec18, 2013. It was a long journey between JNC 7 and 8, it took 10 years! and now it is not endorsed by NHLBI(National Heart, Lung, Blood Institute).
Discharge Against Medical Advice, Pitfalls and Troubleshooting. There is a very interesting article from JAMA in Nov. 2013, explaining of misconception and how misleading is information regarding discharge patient with AMA. I always discuss with residents that signing an AMA form does not mean anything unless you document the patient’s condition and mental status and details of your discussion in medical record.
Dilemma: cough, smoker, discoloured sputum, diagnosis: Bronchitis, now: Abx or no Abx
Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial
What evidence does exist regarding dosage of Ketolorac? Our practice is usually 60 mg IM and 30 mg IV, but interesting review by Medscape showed may be this is not a right dose.
JAMA published an article emphasizing our EM textbooks highlights regarding the simple treatment of MSK back pain are NSAIDS and Acetaminophen and then muscle relaxant.
Epmonthly had a very nice review with a mini board review perspective, regarding common complications of shoulder dislocation and reduction.
We are practicing short term of Steroid in management of asthma and COPD in ED, But this is very nice to hear from our colleagues to prove our practice. JAMA, in June 2013 published an article with concept of short term prednisone for 5 days is not inferior to
Pain management in ED is a challenging topic. Teaching residents to start with NSAIDS vs Narcotics and Ibuprofen- Toradol vs Morphine- Dilaudid , always could be a place for discussion/argument.
I was working on LP study that we did, and found this article from JAMA, very informative. http://jama.jamanetwork.com/article.aspx?articleid=203808
MMWR in latest Grand round section discussed the options for gonorrhea treatment and their recommendation in case of cephalosporin allergy,
and the question is:
Does limiting oral contrast decrease emergency department length of stay? we know the answer is YES, but this is something that we can share with our surgical consultants and as well Radiology colleagues
There are different approaches to Migraine HA, Narcotics, Triptans, NSAIDS, Steroids, … but my approach is combination of Metoclopramide and Diphenhydramine.
Headache “The Journal of Head and Face Pain” Published a Systematic Review regarding Toradol and Migraine headache in Jan, and the conclusion is:
This is the last update in 2012, but I am happy to end this year with one of the most challenging topics in medicine. The article is from J Am Coll Cardiol in Dec. You can find the Full text link here
1. Remeber: Troponin elevation imparts a worse prognosis, irrespective of the underlying etiology.
Am J Respir Crit Care Med published a Practice Recommendations in the Diagnosis, Management and Prevention of Carbon Monoxide Poisoning in Oct 2012. We are almost there to see CO poisoning again, Just some points for quick look:
JACC in 2001 published an article that nicely explained the necessity of interpreting lead aVR in clinical setting. There are 3 categorizes that we should consider in this regard:1. acute…
What does typical chest pain mean? Traditionally, we thought that midsternal chest pain with radiation to left arm and increased with exertion, we just had another discussion on this topic on our grand round and all the studies and even
That is the question: contrast CT or non contrast CT? it is very difficult sometimes to answer, but for some facts such as r/o of appy, divericulitis and other pathologies, why…
TIA is a huge dilemma in ED. It could be challenging from definition to workup to disposition, but recent article in clinics of north America, reviewed the pitfalls in diagnosis and disposition of patients with TIA. TIA is important because there is a chance of Stroke within 48 hours (5%).
What is your favorite hypertension numbers to treat in ED? there are a lots of controversies regarding the exact number to start treatment in ED but recent Cochrane review on mild HTN suggest that antihypertensive agents used in the treatment of adults with hypertension stage I (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg)
Wow. This is the third one, after 2 articles that showed Epi in prehospital really does not decrease mortality , now this retrospective study presenteddata that none of patients with asystole and no
July 2012: Annals of Emergency Medicine:
Early Administration of Systemic Corticosteroids Reduces
We usually believe that pt with sickle cell trait is not as important as SCD(HbSS). In sickle cell trait, RBC has normal life span (120 vs 20) and no vaso-oclusive crisis. But article in the American Journal of Medicine, discussed a series of serious complication that can affect this type of patient ranging from hematuria, renal papillary necrosis,
Annals of Emergency Medicine published an article which it provided a formula to determine if we can differentiate between STEMI vs Early Repolarization. I really do not know in an acute setting I am able to sit down and calculate this but sometimes in terms of training it could be fun to do this practice!!!
I read this article long time ago but I had a discussion with one of my resident and to give her reference I would like to have it here. Basically…
Very detail and informative article regarding Low Back Pain. I believe this article should be read by patients and physicians, and physicians can summarize this for their patients. This is…
There is a State-of-the-Art Paper in the latest edition of Journal of the American College of Cardiology, May 2012.The title of article is New Concepts in the Assessment of Syncope.…
We always taught that Morphine can decrease preload and can help with anxiety and pain in acute flash pulmonary edema. But evidence does not support this Claim.
This is the Standards of Medical Care in Diabetes: 2012 by American Diabetes Association (ADA). There are a lots of useful information can help for new criteria for diabetes and…
This is another article regarding comparison of VBG vs ABG. “Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment”. The other one was in critically ill patient but this one is among patient with diverse medical conditions.
In October 2011, I reviewed an interesting article in Resuscitation, September 2011 regarding use of Epinephrine in per-hospital setting, ,now we have another study published in JAMA, March 2012.
We usually make fun of this topic such as how about have a ct scan in triage and etc.. This is a European study that shows the pan-scan algorithms reduce,…
This is a retrospective cohort study between 2004-2007 among patients who received a treatment with clindamycin, trimethoprim-sulfamethoxazole, or a β-lactam for their skin and soft-tissue infections.
I am teaching this topic to medical students, interns, and residents every month and I found this valuable guideline by World Allergy Organization.
This study is interesting because Maryland EMS has a protocol to give Midazolam IM in prehospital setting. The New England journal published on Feb,16, 2012 a double-blind, randomized study comparing IM Midazolam versus IV Lorazepam for children and adults in status epilepticus.
Jeffry Kline is famous for his research on PE and his latest article in Academic Journal of Emergency Medicine(Jan 2012) is opening another window to PE regarding Normalization of Vital Signs Does Not Reduce the Probability of Acute Pulmonary Embolismin Symptomatic Emergency Department Patients.
The Journal of Clinical Endocrinology & Metabolism published a practice guideline in Jan.2012. Focus of this guideline is management of hyperglycemia in
Journal of Emergency Medicine published an article with title of “Effective Antibiotic Treatment Prescribed by Emergency Physicians in Patients Admitted to the Intensive Care Unit With Severe Sepsis or Septic Shock” in Dec,2011.
This is one of the challenging topics in EM. when should you stop CPR? what parameters do you have to continue versus terminate CPR?
Probably you had this dilemma before. Patient involved MVC with midline neck tenderness and negative CT scan. Now, what should I do? Should I clear and remove c-collar or consult with trauma. There are 2 approaches that trauma surgeons usually do. 1:MRI and/or 2: Flex-ex xray.
I thought I posted this before but I did not, Pediatrcis 2011, prospective cohort study with 2574 patients under 21 years old. Interestingly, 16 % of patients had radiographic pneumonia.
To estimate the frequency and rates of hospitalization after emergency department visits for adverse drug events in older adults between 2007-2009.
IDSA (Infectious Diseases Society of America) published a new guideline this year for treatment of soft tissue infections and MRSA.
I had a patient with Carbon Monoxide poisoning. Patient had mental status changes and was unresponsive.We transferred patient to a hyperbaric center and this is the review that I did with my resident and student for Carbon Monoxide poisoning, mainly from Tintinalli’s:
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The goal of study was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.
Recently, AAP published a practice guideline on “Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children
Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients?
another study on VBG vs ABG, I am sure in ED we almost agreed that a lot of ABG could be replaced by VBG but still among our consultant, this is not as clear as for us. this study
This is a very interesting study regarding usage of epinephrine in out of hospital setting. This is probably the first control trial in human post cardiac arrest. The study is about
How do we measure the fluid status in a patient with shock? This usually measures with CVP or Ultrasound. CVP measurement is possible when we have a central line(subclavian or intra-jugular). Ultrasound brought a quick assessment of volume status or fluid
Top Ten Mistakes in Residency by: Peter Deblieux
We all know that VBG can be replaced with ABG for a lot of reasons, but our consulatants are still asking for ABG in DKA, COPD, Asthma and etc. I will post some data that show VBG is as good as ABG unless you have a patient under vent.
Diagnostic Accuracy of Venous Blood Gas Electrolytes for Identifying Diabetic Ketoacidosis in the Emergency Department.
ACEP’s Video presentation of Dr. Greg Henry and Dr. Gillian Schmitz discussing the top ten documentation mistakes.
Emergency-Medicine-Past-and-Future by: Peter Rosen
How to do Lung Ultrasound to rule out Pneumothorax!
1. Select your probe:
Linear probe, or vascular probe with low penetration and high frequency.
Lung ultrasound in critically ill patients: Comparison with bedside chest radiography. This study was done in Greece and their finding is in general ICU population lung ultrasound