Archive for category: Clinical

Any Benefit to Sodium Bicarbonate in DKA?

12 May
May 12, 2014

In a prior post, we discussed the use of an initial insulin bolus in the management of diabetic ketoacidosis (DKA).  Today we will address another facet of DKA management, for which there is less than optimal evidence and that is: Any benefit to sodium bicarbonate in DKA?  Consensus guidelines for the management of DKA recommended […]

Intravenous Fluids and Alcohol Intoxication

01 May
May 1, 2014

Frequently, patients with acute alcohol intoxication are brought to the emergency department (ED) for evaluation and treatment.  Although practice patterns vary, it is not an uncommon practice to give normal saline to these patients in the hopes that the saline will cause a dilution effect on the level of alcohol helping patients sober faster and […]

Age Adjusted D-Dimer Testing

28 Apr
April 28, 2014

D-dimer testing is sensitive for thrombus formation, and in patients who are not high risk, this test is used to rule-out venous thromboembolism. D-dimer has been shown to increase with age, which can cause a lower specificity (i.e. more false positive tests) in older patients.  Specificity can range from 49 – 67% in patients ≤ 50 […]

Topical Anesthetic Use on Corneal Abrasions

21 Apr
April 21, 2014

Patients with corneal abrasions typically come to the emergency department for eye pain.  Most physicians treat these with topical antibiotics, oral analgesia, and for those who are lucky enough 48 – 72 hour follow up with ophthalmology. Oral analgesia does a poor job of controlling these patients pain. Tetracaine is an esterase type anesthetic with […]

ECG Changes of Hyperkalemia

17 Apr
April 17, 2014

Hyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. It is important to remember that the electrophysiologic effects of hyperkalemia are directly proportional to both the absolute plasma potassium and its rate of […]

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