Archive for category: Mythbuster

Lidocaine + Bupivacaine vs Bupivacaine Alone for Digital Nerve Blocks

09 Apr
April 9, 2015

When 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. Any time additional medications are drawn […]

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

30 Mar
March 30, 2015

Epistaxis 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 a posterior pack and admitted for […]

Beyond ACLS: Epinephrine in Out-of-Hospital Cardiac Arrest Poll

15 Mar
March 15, 2015

Recently, I wrote a post on the use of epinephrine in out-of-hospital cardiac arrest (OHCA) and this triggered some interesting discussion on twitter. Are we at a point that we can just stop using epinephrine in OHCA?  Has anyone stopped actually using epinephrine in OHCA and if so, why or why not? The evidence seems […]

Beyond ACLS: Is It Time to Abandon Epinephrine in Out-Of-Hospital Cardiac Arrest?

11 Mar
March 11, 2015

Epinephrine is widely used and recommended by Advanced Cardiovascular Life Support (ACLS) in out-of-hospital cardiac arrest (OHCA), but its effectiveness in neurologic outcomes has never been truly established.  To verify effectiveness of epinephrine confounders, such as patients, CPR quality, CPR by bystanders, time from call to arrival at scene or hospital, and much much more, […]

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

02 Feb
February 2, 2015

Background: 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 […]

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