Archive for category: Clinical

Does a Porcelain Gallbladder Equal Gallbladder Cancer?

21 Nov
November 21, 2013

Gallbladder cancer (GBC) incidence ranges from 12 – 62% when porcelain gallbladder (PGB) is seen.  You ever wonder where these numbers come from?  Well, these are the quoted numbers from two studies done in 1959 and 1966.  These studies also indicated that if porcelain gallbladder was seen, that a prophylactic cholecystectomy should be performed. Is […]

Should we stop prescribing Azithromycin in the ED?

19 Nov
November 19, 2013

In 2011, Azithromycin was the 7th most prescribed (55.3 million prescriptions) medication according to IMS Health.  There have been several publications indicating that the use of macrolide antibiotics, increase risk of serious ventricular arrhythmias and sudden cardiac death (FDA Adverse Event Reporting System). Specifically, 2 recent studies in the NEJM were published looking at the […]

CPR: Hands-on or Hands-off Defibrillation

01 Nov
November 1, 2013

Pauses in chest compressions are known to be detrimental to survival in cardiac arrest, so much so that the 2010 American Heart Association (AHA) emphasize high-quality compressions while minimizing interruptions. There have been some studies that now advocate for continuous chest compressions during a defibrillation shock. There have been substantial changes to external defibrillation technology […]

Is ATLS wrong about palpable blood pressure estimates?

01 Nov
November 1, 2013

In Advanced Trauma Life Support (ATLS), we learned that a carotid, femoral, and radial pulse correlates to a certain systolic blood pressure (SBP) in hypotensive trauma patients.  Specifically ATLS stated:  Carotid pulse only = SBP 60 – 70 mmHg  Carotid & Femoral pulse only = SBP 70 – 80 mmHg  Radial pulse present = SBP […]

NG Lavage: Indicated or Outdated?

01 Nov
November 1, 2013

Nasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence support the logic? Most studies state that endoscopy should occur within 24 hours of presentation, but the optimal timing within the first 24 hours is unclear.  Rebleeding is the greatest predictor of […]

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