NEJM 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 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 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 […]
Continue ReadingHypoglycemia in the treatment of hyperkalemia in ESRD frequently happens! There ae growing in the body of literature to address this issue with different recommendations: administering 25 g of dextrose with insulin and 25 g of dextrose 1 h after insulin based on our result that hypoglycemia occurred 1–3 h after insulin with dextrose. Link […]
Continue ReadingWe all shaky when we want to start Beta Blocker in COPD Patients! One of the traditional contraindication in COPD patients is using Beta Blcoker, Thorax BMJ reported a study that was done in US and showed betal blockers are associated with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction. […]
Continue ReadingIt has been a very difficult time for Epi since last 5 years! 2011: Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial 2012: Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest 2014: Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients? and now […]
Continue ReadingAmiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest, which one is your choice? The 2015 update of ACLS is still recommending Amio in Vfib, VTach Cardiac arrest after Shock and Epi, But new study in NEJM proved that among 3026 patients who randomized to Amiodarone (974), Lidocaine (993), or Placebo (1059), there were no statistically […]
Continue ReadingCHEST journal Published a systematic review and meta analysis regarding Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT. In this review, in patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis. Link […]
Continue ReadingThere are a lot of controversies around this topic, but It sounds like lowering blood pressure is safe, the following Stroke link recommend SBP 140 is safe, I am not sure the exact number or acceptable number to drop BP but obviously, we should not be worried to drop SBP in hypertensive hemorrhagic stroke as […]
Continue ReadingWhat is your choice to treat chronic joint pain? I know! It is very frustrating for patients and physicians, I took 800mg of Motrin but… and you know Narcotics wont do anything with pain. Lancet in a meta-analysis compared NSAIDs, Acetaminophen, or placebo. They concluded that Diclofenac 150 mg/day is the most effective NSAID available […]
Continue ReadingI would like to quote this again from Dr. Oslser “The good physician treats the disease; the great physician treats the patient who has the disease”. Are we following him? We did not go to medical school to being uncomfortable, we went to medical school to be comfortable , but I don’t think that we […]
Continue ReadingThis maybe an old study, but will give you a sense of what antibiotics will be less favorite for your patients. Among antibiotics Amxicillin and Cefixime have the best taste. Link to article
Continue ReadingAnnals of Internal Medicine published a Multicenter, Double-Blind, Randomized Trial and compared Oral Prednisolone in the Treatment of Acute Gout. Patients were randomly assigned in a 1:1 ratio to receive either indomethacin or prednisolone for 5 days. The regimen was for patients presented to the ED within 3 days of symptom onset. Indomethacin group: patients received […]
Continue ReadingJAMA Published The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) by Physicians from USA, Germany, France, Australia, Canada, Netherlands, and Belgium. The reason for this new definition is the limitation of sensitivity and specificity of SIRS criteria, too much focus on inflammation cascade, and too many terms that really does not make […]
Continue ReadingFound this link in Diagnosis and also in Acad Medicine regarding Patient/Provider safety and how to reduce diagnostic error. also what to do in high risk situations. Take a look specifically for new Grad! Link to article
Continue ReadingIs it real? we had this discussion before: Aortic dissection and contrast, Vertebral artery dissection and contrast, any VTE disease and contrast. but what should be our target GFR, Cre? American College of Radiology onContrast Media in 2015 “At the current time, there is very little evidence that IV iodinated contrast material is an independent […]
Continue ReadingIf we add nasal cannula to nonrebreather face mask or BVM with air leak, we will improve pre-oxygenation phase. This study that just published in Annals of EM enrolled 6o Healthy volunteers ,30 nonrebreather face mask and 30 bag-valve-mask. There will be an argument that Healthy lungs will be different from patients with restrictive or […]
Continue ReadingVery happy to see US guided artery line is now in CHEST! Twelve trials used dynamic two-dimensional (2-D) ultrasound (N = 1,992). The study showed decreases first-attempt failure, mean attempts to success, mean time to success, and the occurrence of hematoma complications. Link to CHEST
Continue ReadingThere is a very good review of managing shoulder dislocation. It is not EBM, but worth to read.
Continue ReadingI am fan of Metoclopramide + Diphenhydramine or Prochlorperazine + Diphenhydramine for Migraine Headache, and I see a lot of good outcome among patients with headache. Annals of EM published “Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department–Based Randomized Clinical Trial”. I am not sure that I am ready to start practicing this […]
Continue ReadingDizziness! one of the most complex and ambiguous term in ED. The first response: what do you mean? But sounds like we need to have more critical thinking than just a vertigo, or lightheartedness. Neurology in Nov.2015 Publishes an article regarding: Stroke risk stratification in acute dizziness presentations! There were 272 patients, 10.7% acute stroke […]
Continue ReadingWe had a long journey to get here! I can’t tell how many times that I had argument with consultants regarding COPD or DKA patient that they ask for ABG and we had VBG! My old Post was focused mostly on DKA patient but Thanks to Throax that published a study among COPD patients. Using […]
Continue ReadingThere are several methods to orally load Anti Epileptic drugs (AED) in ED. Tintinalli’s has 2 approaches: 1.patient with active seizure 2. patient with history of seizure. Patient who had active seizure should receive Phenytoin 15- 25 mg/kg no more than 50 mg/min. For patient in no active seizure: Without a loading dose, phentoin may […]
Continue ReadingI cannot say that we did not know about this, but having an article to support this is very exciting. Jeff Kline and his colleagues analyzed 45 studies of 8,209 patients and found the most EKG findings among patients whom was diagnosed with acute PE: tachycardia (38%), T-wave inversion in lead V1 (38%), and ST […]
Continue ReadingNeurologic clinics has a very nice article regarding BPPV. It explains not only the epidemiology and Etiology , it also discusses the diagnosis maneuver and also treatment options. Link to article
Continue ReadingSounds like we have to move from Bactrim and Cipro to other agents for uncomplicated cystitis. AJEM published an article in Sept and recommends using more local agent for uncomplicated cystitis , instead of systemic antibiotics. The antibiogram in this study showed sensitivity to Trimethoprim-Sulfamethoxazole 75%, Ciprofloxacin 80%, Nitrofurantoin99%, and Cefazolin 96%. AJEM Abstract […]
Continue ReadingWe all see patients with back pain every single day that we are working in ED. Many of them tried different pain medications, muscle relaxant. I have had several presentations on this, but I have to accept that in clinical setting, its difficult to convince some patients that narcotics are not the best approach for […]
Continue ReadingAEM published “A Preprocedural Checklist Improves the Safety of Emergency Department Intubation of Trauma Patients” in July. This is a prospective, pre-post intubation study on 141 trauma
Continue ReadingEvidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society answers very critical questions regarding unprovoked first seizure.
Continue ReadingYou have a septic patient with PCN allergies! and now you are in trouble to start appropriate antibiotics due to cross reactivity. This is an Italian based study, that studied the cross-reactivity and
Continue ReadingNew guideline by MMWR in June 2015, reviewing most important topics in STD. This guideline is very comprehensive and answers several critical questions regarding current and future therapy and focuses on STD.
Continue ReadingHaving a pregnant patient with suspected PE, you know what I’m talking about. It is usually a disaster, mom is worry about fetus, dad is worry about mom, you are worry about both! how much is the risk of PE in pregnancy?
Continue ReadingThere are a lot confusion/controversy regarding appendicitis treatment :ABx vs surgery: The NOTA Study (Non Operative Treatment for Acute Appendicitis) in Ann surg, 2014 showed that antibiotics for suspected acute appendicitis are safe and effective and may avoid unnecessary appendectomy. Long-Term Outcomes of Patients with Nonsurgically Managed Uncomplicated Appendicitis in J Am Coll Surg, 2014 […]
Continue ReadingIn a meta-analysis published in Resuscitation, 10 observational study reviewed and showed among patients with out of hospital cardiac arrest, patients who intubated via ETT had significantly better
Continue ReadingTroponin 1 set, 2 sets, 3 sets, Stress test, Echo, Observation vs Admission. LOW risk chest pain, when will be a safe practice. JAMA internal medicine in March found patients that they do not have
Continue ReadingI was reading an article regarding Managing Afib in Annals of EM. They are recommending Amiodarone 300 mg IV over an hour and then 10-50 mg/hour for 24 hour.
Continue ReadingBe careful, when you are trying to rate control your afib/aflutter patient. Using rate or rhythm control in patient with an acute underlying disease,
Continue ReadingI usually review a question on my board review series regarding a patient with trauma and negative x-ray of hip, what is the next step? The answer is usually CT scan, and I have to admit that this is my routine practice that I do not rely on X-ray, if my patient still is symptomatic,
Continue ReadingRecent post in NY Times, Stroke of Fate , offended many ED physicians. I was not! It was very simple to me. A 78 years old neurologist said “I’m afraid to go to the emergency room,” he added. “I think it’s dangerous.” I agree that this is not a good comment for general population to […]
Continue ReadingJust published regarding high-flow nasal cannula oxygenation, and I just published last Post. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: A randomized controlled clinical trial,
Continue ReadingI believe sometimes we are in rush for no reason. Patient with hypoxia and no reserve requires some oxygen to prevent hypoxia during intubation, DSI vs RSI. I am fan of DSI to buy some time to see how we could assist with oxygenation before definitive airway intervention.
Continue ReadingYou can find in this blog at least 6 references talking about Contrast vs Non contrast CT, but this new study in Annals of EM showed the same result that oral contrast in detecting intra-abdominal pathologies is useless. Wow, this is a big word. USELESS.
Continue ReadingThe BMJ study was a shocking news in 2011 regarding Sensitivity of Modern CT scan in diagnosis of SAH within 6 hours of presentation, Click here for more Then, Storke in 2012 reported another study that showed there is “no added value of CSF analysis to detect SAH within 6 hours of patient presentation with […]
Continue ReadingSIRS criteria an immune response to infection can be diagnosed by ( 96.8<Temp>100.4, HR>90, RR>20 and 4K<WBC>12k). A new study in 172 ICUs among 109,663 patients with infection and
Continue ReadingSurviving Sepsis Campaign updated its guideline regarding new evidence (ProCESS, ARISE, ProMIS). It is required to do a series of actions within first 3 hours and 6 hours of patient presentation(time of triage):
Continue ReadingWhen I saw this article in Annals , I was sure that I have seen it before, but could not believe that 2 studies with almost same methods, same number of patients, and same dose of medication.
Continue ReadingWell, I just sent an article that how important is the role of vital signs during pre-hospital or in ED assessment. Annals of EM published an article: Communication of Vital Signs at Emergency Department Handoff: Opportunities for Improvement. In a prospective observational study, authors observed 1,163
Continue ReadingWe were always told that Don’t underestimate triage or field vital signs! Now, we have a study that shows 25 % of patients presenting to ED with sepsis will progress to septic shock within 3 days.
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