How Long Does a Cough From Respiratory Illness Last?

02 Mar
March 2, 2015

Cough and VirusCough from respiratory illness is one of the most common reasons that patients seek care in both the outpatient primary care setting and the emergency department (ED).  Cough due to respiratory illness is a self-limited condition in the majority of cases, but patients still seek care at clinics and EDs seeking relief or their symptoms. Maybe the reason for this is patients’ expectations of duration of cough and the actual natural history of cough from respiratory illness are mismatched. So how long does a cough from respiratory illness last? Read more →

Any Benefit to Adjunct Prednisone Therapy in Community Acquired Pneumonia?

18 Feb
February 18, 2015

PneumoniaBackground: Respiratory tract infections and pneumonia are the 3rd leading cause of death worldwide.  Although morbidity and mortality has improved slightly with the advent of antibiotics, there is still a significant long-term morbidity and mortality associated with this disorder.  It is well known that in pneumonia, there is an excess release of circulating inflammatory cytokines which cause further pulmonary dysfunction. Maybe the use of systemic corticosteroids, which have anti-inflammatory effects, could help attenuate this systemic inflammatory process and thus improve outcomes. So is there any benefit to adjunct prednisone therapy in community acquired pneumonia?

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February 2015 REBELCast

09 Feb
February 9, 2015

REBELCast LogoWelcome to the February 2015 REBELCast, where Swami, Matt, and I are going to tackle two critical care topics that come up frequently in clinical practice in both the pre-hospital setting as well as the emergency department.  Today we are going to specifically tackle:

Topic #1: Administration of Rapid Sequence Intubation (RSI) Medications via an Intraosseous line.

Topic #2: Compressions During Charging (CDC) in Out of Hospital Cardiac Arrest (OHCA)

Read more →

The PROPPR Randomized Clinical Trial

04 Feb
February 4, 2015

The PROPPR Randomized Control TrialIn the United States, trauma is the leading cause of death among patients between the ages of 1 and 44 years of age and the third leading cause of death overall. Approximately 20 to 40% of trauma deaths occur after hospital admission and are a result of massive hemorrhage.  There have been no large, multi-center, randomized clinical trials with survival as a primary end point that support optimal trauma resuscitation practices with approved blood products and therefore there are many conflicting recommendations. The Prosective Observational Multicenter Major Trauma Transfusion (PROMMT) Trial demonstrated that many clinicians were transfusing patients with blood products in a ratio of 1:1:1 or 1:1:2 and that early transfusion of plasma was associated with improved 6-hour survival after admission.

The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial was designed to address the effectiveness and safety of 1:1:1 transfusion ratio vs 1:1:2 in patients with trauma who were predicted to receive a massive transfusion.

Read more →

Is Kayexalate Useful in the Treatment of Hyperkalemia in the Emergency Department?

02 Feb
February 2, 2015

BariumEnema_ORIGINAL_460x261Background: Hyperkalemia is the most common electrolyte disorder seen in the Emergency Department and treatment of hyperkalemia is core knowledge of EM training for interns and focuses on:

1) Stabilization of cardiac myocytes with calcium salts
2) Temporary shifting of potassium into cells (insulin, beta agonists, normal saline,
      magnesium, sodium bicarbonate)
3) Removal of potassium from the body (i.e. loop diuretics, cathartics)
4) Definitive Treatment (i.e. Hemodyalisis)

Although there is still some debate on the first two areas (i.e. is there truly a role for sodium bicarbonate?) our focus will be on the removal part of the algorithm, specifically, is there a role for kayexalate?

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January 2015 REBELCast

10 Jan
January 10, 2015

REBELCastWelcome to the January 2015 REBELCast, where Swami and I are going to tackle a very important scenario that comes up in the daily practice of not only Emergency Medicine, but also in Medicine.  Today we are going to specifically tackle one topic:

Topic: Is the use of cephalosporin antibiotics in patients with a history of penicillin class antibiotics safe? Read more →

Do Patients with Strep Throat Need to Be Treated with Antibiotics?

05 Jan
January 5, 2015

Background: Streptococcal pharyngitis is a common presentation to primary care and Emergency Department physicians. Every year, 10 million patients in the United States are treated with antibiotics for pharyngitis. However, less than 10% of these patients actually have strep pharyngitis (Barnett 2013). Prescribing of antibiotics for these patients centers on three arguments:

  1. Antibiotics reduce symptomology
  2. Antibiotics reduce the rate of suppurative complications
  3. Antibiotics reduce the rate of non-suppurative complications (primarily Rheumatic Heart Disease).

So, do patients with strep throat need to be treated with antibiotics?

Read more →

September REBELCast

02 Sep
September 2, 2014

rebelcast_logo2Welcome to the September REBELCast 2014, where Matt, Swami, and I are going to tackle a couple more scenarios to help your clinical practice.  Today, we are going to specifically tackle two different topics:

Topic #1: The use of Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pre-Hospital Treatment of Patients with Severe Respiratory Distress
Topic #2: Once Weekly Dalbavancin for Skin Infections Read more →

R.E.B.E.L. ECG of the Week: Wellens’ Syndrome or STEMI

14 Aug
August 14, 2014

Wellens' Syndrome or STEMI

A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.

According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation.  She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest.  Today she awoke with substernal chest pain that never resolved and continued in the emergency department.  She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.

BP 127/89     HR 76     RR 20      O2 sat 100% on 2L NC     Temp 99.3

Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
CTA B
2+ pulses in her extremities, no edema

ECG is shown (No prior ECG for comparison)…..

Read more →

Colchicine for Treatment of Pericarditis

11 Aug
August 11, 2014

PericarditisAcute and recurrent pericarditis are frequently diagnosed in the emergency department.  Traditionally, treatment has consisted of anti-inflammatory medications (eg. ASA or NSAIDs) or corticosteroids.  Colchicine is an underutilized therapy for pericarditis and provides significant benefit when combined with NSAIDs/ASA. Addition of colchicine to standard therapy results in earlier reduction in pericarditis symptoms, greater remission at 1 week, and reduces the rate of recurrent pericarditis. Let’s review the literature for colchicine for treatment of pericarditis. Read more →