Archive for category: Mythbuster

Mythbuster: Glucose Levels Must be Below a “Safe” Threshold Before Discharge

01 Dec
December 1, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Anyone who works in the Emergency Department has seen patients brought in by EMS or sent from the clinic with a chief complaint of “high blood sugar.”  Now, we are not talking about patients with diabetic ketoacidosis, but just simple hyperglycemia. This is a common complaint with no […]

Should We Give Fingertip Amputations with Exposed Bone Prophylactic Antibiotics?

14 Dec
December 14, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Fingertip amputations are not an uncommon injury seen in the emergency department. Treatment options range from healing by secondary intention to flap coverage or replantation. Selection of the appropriate treatment modality depends on the nature of the injury, the physical demands of the patient, and the patient’s co-morbidities. […]

Is Too Much Supplemental O2 Harmful in COPD Exacerbations?

03 Dec
December 3, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: It’s common practice to give carefully titrated supplemental oxygen therapy for patients in COPD exacerbation. We give enough O2 to prevent hypoxemia, but not so much that it causes hypoventilation or dangerous hypercarbia. If you’re like me then you’ve probably heard a number of conflicting theories as to […]

More Dogma: Epinephrine in Digital Nerve Blocks

03 Sep
September 3, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketYou are working as an EM resident and have just evaluated a patient with a right long finger DIP joint dislocation. You perform a digital nerve block with 1% lidocaine with 1:100,000 epinephrine, and go to present to your attending before attempting the reduction. Your attending, on hearing about […]

Medical Expulsion Therapy in Ureteral Colic: An Update

06 Aug
August 6, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBack in August 2014, we posted an in depth review on medical expulsion therapy (MET) with tamsulosin in patients with renal colic. The summary of that post was: “Clearly, there is disagreement in the literature. None of the studies are ideal. We continue to lack a large, RDCT done […]

Morphine Kills in Acute Decompensated Heart Failure

08 Jun
June 8, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Intravenous morphine use has been reported in nearly one of seven patients hospitalized with acute decompensated heart failure (ADHF). I have anecdotally, even seen physicians giving morphine as a “first-line” agent: Nitroglycerine, Non-Invasive Positive Pressure Ventilation (NIPPV), and Morphine. There is surprisingly little evidence supporting routine use of […]

Mythbuster: Administration of Vasopressors Through Peripheral Intravenous Access

28 May
May 28, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Vasopressors are frequently used in critically ill patients with hemodynamic instability both in the emergency department (ED) as well as intensive care units (ICUs). Typically, vasopressors are given through central venous catheters (CVCs) as opposed to peripheral intravenous (PIV) access due to the concerns about adverse events (i.e. […]

Do Patients with Posterior Epistaxis Managed by Posterior Packs Require ICU Admission?

13 Apr
April 13, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketThis post is part 2 of epistaxis dogma. In the first post, we discussed the (dis)utility of prophylactic antibiotics in patients with epistaxis who require nasal packing. Here, we will take on dogma #2: Dogma #2: Patients with posterior packs for epistaxis should be admitted to the ICU for […]

Lidocaine + Bupivacaine vs Bupivacaine Alone for Digital Nerve Blocks

09 Apr
April 9, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketWhen I first learned digital nerve blocks in the late 1990’s I was taught to mix Lidocaine and Bupivacaine 50/50 to provide faster onset (Lidocaine) and a longer duration of action (Bupivacaine). My use of two agents for digital nerve blocks was recently questioned by one of my colleagues. […]

Do Patients with Epistaxis Managed by Nasal Packing Require Prophylactic Antibiotics?

30 Mar
March 30, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketEpistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 2008, Pallin 2005). Posterior epistaxis is considerably less common than anterior epistaxis and represents about 5-10% of all presentations. Many patients with posterior epistaxis will be managed with […]

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