Welcome back to Episode 41 of REBEL Cast. In this episode, we will be discussing some studies from the past year that caught our attention in the area of resuscitation. Again, this 3 part series will be dedicated to discussing current literature and how it can be applied to your clinical practice. Read more →
Author Archive for: srrezaie
Background: Acute Aortic Syndromes (AAS) are life threatening cardiovascular emergencies that are the bane of every emergency physician’s existence. They are diagnostic challenges due to the clinical presentation being highly non-specific. Computed tomography angiography (CTA), Transesophageal Echocardiography (TEE), and Magnetic Resonance Angiography (MRA) can help accurately diagnose AAS. CTA exposes patients to radiation and large doses of intravenous contrast, neither of which is a good enough reason to skip the test in patients you think may have a dissection, but certainly not something we want to do to all patients coming to the ED with chest pain. TEE and MRA may not be available or able to be performed in a timely manner. Having a clinical algorithm that can help physicians reduce misdiagnosis and at the same time avoid over-testing are lacking. Read more →
Welcome back to Episode 40 of REBEL Cast. We have taken some time off but don’t worry, we are back. In this episode, we will be discussing some studies from the past year that caught our attention, dealing with pain control. With the hundreds of journals in EM/CC and the thousands of publications it is hard to stay up to date with current research. This 3 part series will be dedicated to discussing current literature and how it can be applied to your clinical practice. Read more →
Background: First trimester vaginal bleeding is a common complaint seen in the emergency department. Patients are obviously stressed about the possibility of miscarriage while providers are stressed about missing diagnoses such as ectopic pregnancies. There have been multiple studies questioning the interrater reliability of the pelvic examination. A more important question however, is does the pelvic examination provide any benefit to these patients by enhancing management and decreasing morbidity? Read more →
Do Patients with Opioid Dependence Benefit from Buprenorphine/Naloxone Treatment Initiation in the Emergency Department?
Background: North America’s current opioid crisis, much of it iatrogenic (2), has led to significant increases in ED visits associated with opioids (3). These patients often present after poisoning, in withdrawal, or with other health issues associated with their disease.
It is well accepted that Opioid Replacement Therapy (ORT), namely, methadone and buprenorphine/naloxone, are successful harm reduction agents shown to improve health and social outcomes (4). Several individual providers, and even large academic institutions, have started initiating ORT, specifically buprenorphine/naloxone, in the ED when dependent patients present in withdrawal.
D’Onofrio et al., in 2015, published outcomes after 30-days from a clinical trial of patients who met criteria for opioid dependence in the ED that were randomized to one of three interventions: referral, brief intervention or ED-initiated buprenorphine followed by 10 weeks of continued buprenorphine treatment in a primary care setting (5). They found that patients receiving ED initiated buprenorphine with continuation in primary care were more likely to be engaged in formal addiction treatment at 30 days (p < 0.001). More recently, they have published follow-up outcomes on a subset from the original study at 2, 6 and 12 months. Read more →