We frequently encounter non-emergent conditions in our clinical practice, such as peripheral neuropathy, which may not represent an acute emergency but can be significantly disabling for patients. A comprehensive and up-to-date review published in JAMA provides an in-depth overview of this topic, offering valuable guidance for our emergency providers. Link to article
Continue ReadingDefibrillation is often considered ineffective in hypothermic cardiac arrest patients with shockable rhythms, particularly at core temperatures ≤30 °C, and the optimal timing and number of shocks as well as the role of rewarming have remained uncertain. However, a retrospective observational study published in Resuscitation showed that defibrillation attempts can be successful even before rewarming […]
Continue ReadingThere remains significant controversy regarding the optimal induction agent for rapid sequence intubation (RSI), particularly when comparing etomidate and ketamine. Concerns surrounding etomidate center on its potential to cause transient adrenal suppression, which has raised questions about possible harm in critically ill patients. However, it is unclear whether this theoretical risk translates into meaningful clinical […]
Continue ReadingThe American Headache Society recently published updated guidelines for the acute treatment of migraine in adult patients presenting to the emergency department. Based on the strength of available evidence, intravenous prochlorperazine was classified as highly likely to be effective, supported by multiple Class I studies. Intravenous metoclopramide and intravenous ketorolac (personal opinion: we have to […]
Continue ReadingIn a recent guideline, the Infectious Diseases Society of America (IDSA) distinguished between complicated and uncomplicated urinary tract infections (UTIs). Recognizing that prior definitions were often vague and overly broad, the guideline adopted a more straightforward approach, categorizing infections based on whether they are localized to the bladder or extend beyond it, in conjunction with […]
Continue ReadingJAMA recently published a randomized controlled trial evaluating the treatment of peripheral vertigo using three arms: sodium bicarbonate, diphenhydramine, and their combination. The study concluded that combination therapy provided superior outcomes compared to either agent alone. Exclusion Criteria were: Refusal to participate, Pregnancy, Prior use of antivertigo medication, Symptom duration > 24 hours, Heart failure, […]
Continue ReadingThe threshold for D-dimer remains an important topic in emergency medicine, critical care, and pulmonology. Emerging evidence, particularly from the 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) introduced by Roy et al., suggests that we may need to adjust risk stratification and corresponding D-dimer thresholds. Recent data published in The Lancet Respiratory Medicine indicate that […]
Continue ReadingWhat is the diagnostic accuracy of ECGs in hyperkalemia? Ünlü et al. conducted a study evaluating how well electrocardiogram findings detect hyperkalemia and predict clinical outcomes in the emergency department. Their results showed that ECGs perform poorly as a diagnostic tool for identifying or excluding hyperkalemia. Link to article Link to another article
Continue ReadingAnd the question is: Metoprolol vs. Diltiazem for atrial fibrillation? The more you explore this topic, the more fascinating and nuanced it becomes. When I wrote a chapter on this for Short Stay Management of Atrial Fibrillation, I initially thought we had thoroughly reviewed the evidence. However, during our later systematic review and meta-analysis, we […]
Continue ReadingMy first exposure to the literature on transfusion thresholds in critically ill patients was through the landmark study by Hebert et al. , which compared restrictive (7 g/dL) versus liberal (9 g/dL) transfusion strategies. The authors concluded that a restrictive approach was at least as effective as, if not superior to, the liberal strategy. My […]
Continue ReadingI’ve never routinely used tramadol in my practice, as I’ve never been fully convinced of its therapeutic role. I acknowledge my bias toward this medication; however, a recent article in BMJ Evidence-Based Medicine discussed its use in reducing chronic pain, noting only a low certainty of evidence. Given the current evidence, the risks associated with […]
Continue ReadingJAMA recently published a guideline addressing management of major procedures in patients with thrombocytopenia, outlining evidence-based platelet transfusion thresholds for various clinical settings. Link to article
Continue ReadingNecrotizing fasciitis and limb salvage represent serious complications of gas-producing infections that require timely and critical intervention to prevent catastrophic outcomes. These conditions are both limb- and life-threatening, demanding rapid recognition and coordinated management. This review provides valuable guidance on empiric antibiotic selection that can be initiated in the emergency department, along with the importance […]
Continue ReadingThis month we have two important updates from the American Heart Association (AHA). The Circulation journal has released new guidelines for the management of adult hypertension. It is particularly interesting to see how these recommendations differ in defining high blood pressure and related thresholds compared to prior guidelines. Hypertension journal has already put some debates […]
Continue ReadingThe American Thoracic Society has recently published a Clinical Practice Guideline addressing key aspects of the diagnosis and management of community-acquired pneumonia (CAP). The guideline offers evidence-based recommendations on several clinically important questions, including the role of concurrent testing and treatment for viral infections in high-risk populations and the optimal duration of antibiotic therapy. Link […]
Continue ReadingA recent research question on the relationship between head-of-bed positioning and clinical deterioration in patients with large vessel occlusion (LVO) stroke was addressed in the June edition of JAMA. Only a small number of studies have examined this topic in recent years. The current study demonstrated that a 0° head position was superior to a […]
Continue ReadingEach time I come across another article on this topic, I tell myself it will be the last time I read one — yet somehow, I keep coming back. The ongoing debate over whether lactated Ringer’s (LR) is better than normal saline (NS), or vice versa, seems endless. The recent NEJM article concluded that there […]
Continue ReadingI found this article very helpful and practical, particularly for situations when a patient presents with a facial fracture and no specialist or subspecialist is immediately available. It provides valuable guidance on which injuries may not warrant emergent consultation. In fact, the article published in the current issue of Journal of Trauma and Acute Care […]
Continue ReadingStarting antibiotics in sepsis is always a clinical dilemma; however, timely administration is one of the few interventions clearly shown to reduce mortality in septic patients. A recent study published in Clinical Infectious Diseases demonstrated that initiating treatment with a β-lactam antibiotic followed by vancomycin had a modest impact on reducing in-hospital mortality. Link to […]
Continue ReadingIt is encouraging to see how data have informed such a critical concept in acute care medicine. Hyperkalemia is a life-threatening condition surrounded by significant clinical uncertainty and misconceptions. The lack of high-quality evidence regarding which agents are truly effective has long posed a challenge. This systematic review brings together the available evidence to clarify […]
Continue ReadingIn cases of hyperemesis gravidarum, our initial approach typically involves administering glucose-containing solutions to address ketosis. A recent study published in Pediatric Emergency Care demonstrated that, in the pediatric population, higher intravenous glucose administration was associated with a reduced risk of hospitalization and lower rates of return visits. Link to article
Continue ReadingBacterial vaginosis (BV) can sometimes be challenging to treat effectively. While standard oral antibiotics, such as metronidazole, are generally effective, some cases require switching to clindamycin for better outcomes. A recent open-label randomized controlled trial published in the New England Journal of Medicine in March 2025 evaluated the treatment of male partners with oral metronidazole […]
Continue ReadingWe often tend to spend more time on pediatric resuscitation and CPR compared to adults. However, the question remains: what is the optimal duration of resuscitation efforts in these patients before considering termination? A recent retrospective study from Japan addressed this issue and found that fewer than 1% of children achieved favorable neurological outcomes (defined […]
Continue ReadingA pre-post study conducted in North Carolina compared multi-dose epinephrine with single-dose epinephrine in adult non-traumatic out-of-hospital cardiac arrest (OHCA) patients. The authors concluded that patients with bystander CPR and a shockable rhythm who received only a single dose of epinephrine had a higher survival rate to hospital discharge compared to those who did not […]
Continue ReadingThe overuse of azithromycin during COVID-19 led to several issues, including increased resistance to the medication. Initially, concerns centered around QT prolongation, but a recent retrospective study published in JACC: Advances discusses additional risks associated with azithromycin exposure, including ‘long-term subsequent MI,’ ’30-day hospital readmissions,’ and ’30-day incident heart failure among MI patients.’ Link to […]
Continue ReadingI personally believe that having a secure line, whether a peripheral IV or central line, is essential for resuscitating a patient. However, this is just my opinion. A recent article in NEJM highlighted that the drug administration route—IV versus IO—matters in terms of successful resuscitation, return of spontaneous circulation (ROSC), and favorable neurological outcomes. Link […]
Continue ReadingEpinephrine and cardiac arrest: what’s the question? How much epinephrine is enough? Garcia et al. published a retrospective study in AJEM discussing cumulative epinephrine dosage in cardiac arrest. Although the study includes a variety of patient settings, such as CT surgery and cath lab patients, which may not be directly applicable to ED patients, it’s […]
Continue ReadingA retrospective study published in the Critical Care journal investigated the impact of intravenous thiamine administration on clinical outcomes in septic patients. The study evaluated key parameters, including lactate clearance and overall mortality. Link to article
Continue ReadingThe history of publishing hypertension guidelines traces back to the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The most recent guideline published under the JNC banner was the JNC 7, which was released by the National Heart, Lung, and Blood Institute (NHLBI). The latest JNC 8 was published […]
Continue ReadingResuscitation recently published an article that assessed the association between intramuscular (IM) epinephrine and survival outcomes, including survival to hospital discharge, survival to hospital admission, and functional survival. Although there is ongoing debate regarding the role of epinephrine in cardiac arrest, this study demonstrated that IM epinephrine improved survival. Link to article
Continue ReadingThe accuracy of EKG diagnosis following cardiac arrest and return of spontaneous circulation (ROSC), particularly when determining the need to activate the Cath lab during the middle of the night, can be highly challenging. Baldi et al. published this study regarding “Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography […]
Continue ReadingI will collect data regarding utility of Steroid in Allergic reaction in this post: Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses ASCIA Guidelines – Acute Management of Anaphylaxis Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis Steroid Management of […]
Continue ReadingThe New England Journal of Medicine has been a leader in publishing recent studies on Paxlovid for COVID-19. Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19 Oral Nirmatrelvir–Ritonavir as Postexposure Prophylaxis for Covid-19 Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19 JAMA: Nirmatrelvir-Ritonavir and Symptoms in Adults With Postacute Sequelae of SARS-CoV-2 InfectionThe STOP-PASC […]
Continue ReadingIbuprofen has analgesic, anti-inflammatory, and fever-reducing effects. Although studies have investigated the proper dosage of ibuprofen as a pain reliever, the optimal dose for each specific effect is not thoroughly studied. In a study published in Annals of Emergency Medicine, Motov et al. examined various dosages of ibuprofen as a pain reliever. They compared 400, […]
Continue ReadingIn November 2023, JAMA published an article on noninvasive airway management among patients with depressed consciousness. The watch-and-wait approach, involving close monitoring for individuals with traditional GCS scores <9 and suspected acute poisoning, demonstrated positive outcomes. Link to article
Continue Readingin a recent article that published in JAMA, Qiam et al. found among 2,511 patients who received antibiotic treatment, it was determined that treatment with piperacillin-tazobactam did not lead to a higher occurrence of acute kidney injury or mortality. Conversely, treatment with cefepime was associated with an increased risk of neurological dysfunction. Link to article […]
Continue ReadingHelsloot et al. found in a retrospective analysis that the first several hours of resuscitation in patients with thoracic injuries are absolutely critical. The majority of fatalities occur within the first hour, and a significant portion of deaths occur within the initial six hours following the injury. Link to article
Continue ReadingIn a recent article published in the British Journal of Surgery, Jain et al. conducted a multicenter superiority randomized controlled trial (RCT) involving 451 children with nail bed injuries. The study showed that, following nail bed repair, discarding the fingernail yielded similar rates of infection and cosmetics ratings as replacing the fingernail Link to article
Continue ReadingA recent study by Savage et al., utilizing propensity score matching, revealed that children under 17 years of age diagnosed with acute sinusitis demonstrated no significant difference in the rate of treatment failure between those receiving amoxicillin and those receiving augmentin. However, it is worth noting that the latter group had a higher risk of […]
Continue ReadingA recent prospective study was published in CHEST regarding the use of peripheral administration of Norepinephrine in ICU. 603 patients received medication through peripheral IV access, and they found almost half of patients did not require central access, and 35 patients had extravasation with no significant complications. Link to article
Continue ReadingLMWH traditionally was recommended for venous thromboembolism (VTE) treatment in cancer patient. Recent JAMA article that enrolled 671 patients between 2016 and 2020 found DOACs are non inferior to LMWH for preventing recurrent VTE over 6-month follow-up . Link to article
Continue ReadingThis is an observational study among patients presenting to 3 EDs with Seizure and they found approximately 12 % of patients had some neuroimaging findings! Link to the article
Continue ReadingAs you know, I usually link peer review manuscripts in this page, but I found a recent publication by ACEP Now very informative. How To Avoid Missing an Aortic Dissection
Continue ReadingNEJM study in 2016 showed no survival benefits or favorable neurological outcome regarding use of Amiodarone vs Lidocaine vs placebo in OHCA. In a recent publication by Acad Emerg Med, a post hoc analysis of original study was done and the authors found time to Amiodarone in OHCA could be associated with better survival to […]
Continue ReadingThere is always a debate in the ED that should we send a patient status post ROSC to cath lab or not. JAMA in July 2022 published a French national multicenter study regarding OHCA patient who had a ROSC to assess cerebral performance category. They enrolled 279 patients and they measured 180 days survival rates. […]
Continue ReadingJAMA published a retrospective cohort study among septic patients who received vasopressor (norepinephrine) and hydrocortisone to show if adding fludrocortisone was more effective to this regimen compare with only giving hydrocortisone. 88275 patients reviewed and in hospital mortality and discharge to hospice as a primary outcome measured. Patients treated with combination of hydrocortisone-fludrocortisone (47.2%) had […]
Continue ReadingThis is a good controversial review in favor or against Intravenous haloperidol. It is important to know that IV haloperidol is not FDA approved. QT Prolongation, Torsades de pointes, and alternative agents for sedation always should be considered. Intravenous Haloperidol Has a Limited Role in the Modern Emergency Department Haloperidol May Be Safely Administered Intravenously […]
Continue ReadingBased on this European study that involved colleagues from France, Italy, Switzerland included 2164 patients, 69% needed emergency hemorrhage control, 6 % received prehospital PRBC transfusion, 25% had massive transfusion. They concluded that “early norepinephrine infusion was not associated with 24-hour or in-hospital mortality among patients with blunt trauma and hemorrhagic shock.” Link to article
Continue ReadingA Systematic Review and Meta-analysis published in JAMA focusing on choice of medication for patient with vertigo. They reviewed 27 trials and they found that there is a moderately strong evidence to suggest that “single-dose antihistamines provide greater vertigo relief at 2 hours than single-dose benzodiazepines”. Link to article
Continue ReadingThere are bunch of rumors that come to play regarding what other medications we can use in cardiac arrest patient, Calcium, Sodium Bicarb, tPA,… A study published in JAMA tried to answer part of this question: “Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest, […]
Continue ReadingDoes Anterior-Posterior electrode pad work better than the Anterior-Lateral position? A multicenter Danish study in 468 patients with atrial fibrillation showed the Ant-Lat position was more effective than AP for biphasic cardioversion and converting to sinus rhythm. There was no safety concern between these 2 methods. Link to study
Continue ReadingThe choice of vasopressor is always a topic of controversy regarding post cardiac arrest patients. Intensive Care Medicine recently published an article with focus on “Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock”. This study was in Paris metropolitan region. They included 766 patients and they found using Epi in OHCA post cardiac […]
Continue ReadingVery interesting study in patients who got ROSC and had an ECG. Patients with an ECG before 7 minutes after ROSC had more false positive ECG findings in favor of STEMI vs 8-33 minutes and more than 33 minutes. Link to study
Continue ReadingMy last post discussed the magnitude of blood pressure reduction specifically within first 6 hours of ICH! Now the current study really questioned the impact of aggressively lowering BP on outcome of patients with ICH! I believe our practice guideline should be based on sustained high quality studies, and persistent EBM, and not based on […]
Continue ReadingWe have learned that BP control in paints with ICH can help with their outcome. Neurocritcal care in a multi-center study showed that this may not direct us to a better outcome. Link to study
Continue ReadingThere are two studies published by American Journal of Emergency Medicine and European Journal of Emergency Medicine on this topic. Turgut and Yauz reported that CPAP lowered the amount of CO in the blood faster than the mask on 45 patients. Bal et al. reported that CPAP therapy may be an effective option for oxygen […]
Continue ReadingWhen we published our review “The controversial role of dual sequential defibrillation in shockable cardiac arrest”, our conclusions was further studies are necessary to assess the efficacy and safety of DSD compared to the standard of care treating refractory VF. AEM published another study exactly one year later: Prehospital Double Sequential Defibrillation: A Matched Case-Control […]
Continue ReadingWe know the first approach to seizure usually is benzodiazepines after ABC, but in status epiliepticus we should start another agent to control patient’s seizure activity that does not stop or have a breakthrough. NEJM in a RCT of 3 AED reported that levetiracetam, fosphenytoin, and valproate each: could stop seizure activity in half of […]
Continue ReadingJAMA Published a study and proved that intensifying high blood pressure treatment among 4056 patients, before sending the patient home, was not associated with reduced cardiac events or improved BP control, and they will return with adverse events and also will be readmitted. Link to article
Continue ReadingLevetiracetam versus phenytoin? Which one do you use in case of status epilepticus in children? A multicentre, open-label, randomised trial publishe by the Lancet suggests that levetiracetam could be an alternative “as the first-choice, second-line anticonvulsant in the treatment of paediatric convulsive status epilepticus.” Link to article
Continue ReadingWestJEM published an article regarding residency interview. This review discuss mock interview, interview questions, inappropriate interview questions, scheduling interview, Peri-Interview Interactions, and many more issues that you will face during an interview. Link to article
Continue ReadingWhen do you discharge a patient with opioid OD? Is it awake, alert ox3, Passed road test, articulate well? AEM published a prospective clinical prediction rule to assess when a patient is ready to be discharged! Hospital Observation Upon Reversal (HOUR) with naloxone will assess patients one hour after administration of prehospital naloxone. Six criteria […]
Continue ReadingI may not activate cath lab during night shift for ROSC, status post cardiac arrest with no sign of STEMI! Lemkes et al. found in a multi-center cardiac arrest study among patients with immediate vs delayed coronary angiography that there is no survival benefit at 90 days. Link to PubMed
Continue ReadingWe know interruptions during cardiac arrest will have a worse outcome but intubation during a cardiac arrest for several reasons decreased survival rate among these patients. JAMA study measured good functional outcome among patients were intubated during the first 15 minutes and who were not intubated within the first 15 minutes! JAMA Full text
Continue ReadingWe reviewed this topic here, and we published our review in AJEM. Now Anesthesiology in Feb published a study from ICU with the same topic. Patients admitted to the hospital for a biphasic allergic reaction was observed in ICU and 4/83 (5 %, 3 possible, 1 probable) of patients experienced a mild recurrent reaction and […]
Continue ReadingVery helpful practice guideline that published recently in Annals of EM. Topics covered in this issue are: Contraindications, Fasting state,bolus and infusion dosage, personnel, co-administration, monitoring, and adverse events. Link to article
Continue ReadingVery Useful statement for taking care of patients with chest pain, not shocking news, but interesting to see in cardiology literature, they appreciate our concerns: Acute ischemia was diagnosed in 22% of patients who presented to the ED with sharp or stabbing pain and in 13% of those with pleuritic pain. Seven percent of patients […]
Continue ReadingACEP Now published a 5-Step Approach to the Agitated Patient in Nov. 2018, I believe this is a very good resource for our resideints. The 5 steps are categorizing agitation as mild, moderate, or severe, nonpharmacologic de-escalation for mildly or moderately agitated patients, “code white” for moderately and severely agitated patients, safe and effective physical […]
Continue ReadingAEM published a small sample size randomized, double-blind, placebo-controlled trial regarding adult ED patients with gastroparesis. Administration of 5 mg of haloperidol intravenously plus conventional therapy was superior to placebo in these patients. Link to article
Continue ReadingThere was a growing interest regarding usage of antibiotics in upper GI bleed, but the Cochrane review just focused on role of antibiotic in cirrhotic patients. Episode 102 GI Bleed Emergencies Part 2 Link to article
Continue ReadingWhat is your choice of IM medication for a patient who is very difficult to verbally be redirected, and being agitated, combative, and required to be sedated? Happy to see the old practice is still effective: Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department Ann Emerg Med. 2018 Jun […]
Continue ReadingBMJ published a a prospective, double-blind, double-dummy, randomised controlled trial regarding Intravenous versus oral Acetaminophen. 87 participants were enrolled. No superiority was demonstrated in this trial with 1 gram intravenous acetaminophen compared with 2 x 500 mg oral acetaminophen in terms of efficacy of analgesia and no difference in length of stay, patient satisfaction, need […]
Continue ReadingThere are growing body of literature recommending antibiotics for small skin abscess after incision and drainage. Antibiotics after incision and drainage was area of interest for many reseacrhers. N Engl J Med Annals of EM BMJ
Continue ReadingI had a patient with perisstent Supraventricular tachycardia (SVT). My approach usually starts with REVERT, and if unsuccessful will continue with Adenosine. Adensoine with its rapid onset, and short half-life regardless of teribble expeince for patient is a great medication, but in this particular patient in 2 occasions was converting SVT to Sinus rhythm and after […]
Continue ReadingIs Dexamethasone an option to treat sore throat ? A JAMA study on 565 patients in a randomized clinical trial showed “a single dose of oral dexamethasone(10 mg) compared with placebo did not increase the proportion of patients with resolution of symptoms at 24 hours. However, there was a significant difference at 48 hours.” Link […]
Continue ReadingAnother Canadian risk score published in AEM, discussing Short-term Risk of Arrhythmia among Patients With Syncope. This is a multicenter prospective cohort study with 5,010 patients. This study had very good sensitivity: 97% and very poor specificity 53%. Please take a look at the study for 39 different variables that they considered. Link to Abstract
Continue Reading“Sign out”, “Hand off” is one of the critical action for EM physicians. SBAR (Situation, Background, Assessment, Recommendation) is one of the famous procedure to standardize this action. I-PASS initially came for Pediatric literature is an alternative way to summarize and give some standardize protocol for hand off. Pediatrics Academic Medicine
Continue ReadingRegistry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure is a prospective, multicenter study was done in Japan. The goal of study was to observe association between time to Furosemide and clinical outcome among patients visiting ED. 1,291 was registered , 481 patients were in early treatment group. The […]
Continue ReadingThe short answer is: If you have a simple corneal abrasion and you sure about it, giving a topical anesthetic will not decrease risk of healing within 24 hours. Link to article
Continue ReadingIt is very interesting that how fast we are changing our practice lately. Still remember when we started to give double dose of TMP/SMZ plus cephalexin for cellulitis, and then we changed it to 1 dose of TMP/SMZ + cephalexin and then we doubted if cephalexin is necessary or not. JAMA published a randomized study […]
Continue ReadingA very great review regarding new onset seizure and systematic approach. Unfortunately, lacking ED setting, but worthwhile reading it. Interestingly, from 8% to 10% of the population will experience a seizure, 2-3% may develop epilepsy. Link
Continue ReadingI have been teaching back pain for a long time, and I have to say that there has not been a lot of change over very long period of time! American College of Physicians published the most recent guideline in Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Again narctoics! are not recommended […]
Continue ReadingThere are 3 recent studies regarding this subject: Hollingsworth et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. The greatest benefit might be among those with larger stones. Wang RC et al. Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis. Tamsulosin significantly improves stone passage […]
Continue ReadingAnnals of Emergency Medicine in a study published in Dec 2016 showed that there is no association between discharge glucose and 7 days outcome! Link to article
Continue ReadingA randomized double-blind study published in Annals of emergency medicine showed that Ketorolac in doses of 10, 15, or 30 mg intravenously has no differences in terms of analgesic effect at 30 minutes. This study did not go over 2 hrs and does not give us any information regarding prolonging pain medication, but for acute onset pain […]
Continue ReadingThe new guideline by IDSA published’ Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.” There are some answered questions that previously we were practicing based on them. I. Should Patients With Suspected VAP Be Treated Based on the Results […]
Continue ReadingLancet Published a study from Qatar and Australia, comparing Diclofenac Vs Morphine Vs Acetaminophen! Not surprising still NSAIDs are promising to control the symptoms. Link to article
Continue ReadingChoices of anticoagulation therapies are not simple as it was before, it does not mean that it was safer before. The new guideline from CHEST gave Level 2B recommendations to the new generation of NOVACs. Dabigatran (Grade 2B), Rivaroxaban (Grade 2B), Apixaban (Grade 2B), or Edoxaban (Grade 2B) was reviewed. Link to article
Continue ReadingI think everyone is practicing based on Hb&Hct threshold. We have great studies show Hb of 7 could be the trigger point to start for blood transfusion. The latest publication from JAMA showed that we are in a right direction in our practice. Link to article
Continue ReadingChest published an article regarding risk of chronic pulmonary obstructive disease and pulmonary embolism. There are different reported risk from 3% to 30%. In this study, prevalence of pulmonary embolism in unexplained acute exacerbation of COPD reported as high as 16%. We should be worry about PE in patients with unexplained acute exacerbation of COPD […]
Continue ReadingThis is an interesting review of 8209 patients with PE. 3 most common finding that predict shock in PE patients are: Tachycardia, T wave inversion in V1, and ST elevation in aVR. They found six predictor in these patients: Tachycardia S1Q3T3 ST elevation aVR T wave inversion V1-V4 Complete RBBB Atrial Fibrilation Access to […]
Continue ReadingLarge Vessel Occlusion Stroke (LVOS) is an indication for activating stroke team. IR will be on board and this is level IA recommendation from 2015 AHA/ASA Guideline. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) extracted from NIHSS. LVOS were defined by total occlusions involving the intracranial ICA, MCA-M1, MCA-2, or basilar arteries. FAST-ED scoring […]
Continue ReadingWe discussed this topic before in here, here, and here! JAMA published a prospective study with overall negative predictive value of 99.2% for patients with cspine injuries and a negative predictive value of 99.8% for ruling out cspine surgeris that required immobilization or stabilization. Link to article
Continue ReadingBritish Thoracic Society/Intensive Care Society published a guideline regarding ventilatory management of acute hypercapnic respiratory failure(AHRF). I believe there are good recommendations for junior residents who do not know to deal with NIV machine and also setting initial parameter. This is augment our practice that how to approach COPD patient in ED with NIV. Link […]
Continue ReadingWhen we reviewed 3 previous studies here, here and here. We mentioned that should we really treat simple Skin abscess? NEJM published “Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess” in March 2016. Patients were randomised to TMP-SMZ 320-1600 mg twice a day for 7 days versus Placebo in patients greater than 12 years old with […]
Continue ReadingExpert panel from American Headache Society Published a guideline! to manage Migraine Headache in ED in Headache June 2016. They searched and found 68 randomized controlled trials. I am very happy to see our routine practice to treat headache in ED, now after years is coming to Neurology Guideline! Metoclopramide and prochlorperazine offered as level […]
Continue ReadingPATCH is a European based study that published in Lancet in May 2016. PATCH is trying to investigate the effects of platelet transfusion on acute intracranial bleed after using anti-platelet therapy. Study had 2 arms with 95 patients in each arm randomized to standard of care versus platelet transfusion in patient with intracranial bleed on anti […]
Continue ReadingWe discussed this in 2015, but new study in Clinical Infectious Dis. again recommends antibiotic use in uncomplicated wound infection. They do not give an exact meaning of uncomplicated wound infection but we can say whenever physician meant to treat wound infection! This is a randomized, double-blind study at 5 US emergency departments. Patient received […]
Continue ReadingCan we use Dexa instead of Prednisone when we are discharging patient home? old question and as I remember the answer was always Sure! but why are we asking still this question: Symptomatic improvement following emergency department management of asthma: a pilot study of intramuscular dexamethasone versus oral prednisone. J. Asthma 1997 2 articles within […]
Continue ReadingOne of our favorite question in ED is: “Does this patient with chest pain have ACS?” JAMA in Nov. 2015 tried to answer this question from the eyes of cardiologist in ED! Patient presented to ED with chest pain evaluated from 1995 to 2015. History, physical exam, ECG, clinical decision rule and Troponin were examined […]
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