Triage ECGs: Reducing Interruptions in a Busy ED

09 Mar
March 9, 2017

Background: Lets face it. All of us have been interrupted by the onslaught of triage ECGs for interpretation.  This constant flow of pink paper with black scribble causes frequent task switching, interrupts train of thought, and ultimately can lead to medical errors, which affects the patients in front of us.  On the other hand, it is important to avoid delays in care and, in accordance with the American Heart Association guidelines, ECGs in triage should be obtained and interpreted by an attending emergency physician within 10 minutes of arrival to the emergency department for any patients with concerns of acute coronary syndrome. Is there a way to maybe minimize the number of interruptions? Read more →

Pediatric Septic Hip

06 Mar
March 6, 2017

Pediatric Septic Hip Definition: Bacterial infection of the hip joint space and synovial fluid

Background:

  • Causes
    • Hematogenous spread in bacteremia
    • Local spread (i.e. from osteomyelitis)
    • Direct inoculation (traumatic or surgical)
  • High-Risk Subgroups
    • Age < 2 years (peak incidence 6 – 24 months)
    • Immunocompromised state (i.e. AIDS, active cancer, etc)
    • Functional asplenia (i.e. sickle cell disease)
  • Complications
    • Sepsis
    • Osteomyelitis
    • Chronic arthritis
    • Osteonecrosis
    • Capsule damage

Read more →

Effectiveness of Diazepam Adjunct Therapy in Acute Low Back Pain

02 Mar
March 2, 2017

Background: Low back pain is an extremely common presentation to US Emergency Departments (EDs) representing 2.4% or 2.7 million visits annually. The vast majority of presentations are benign in etiology but can be time consuming and frustrating for both patients and physicians. For patients, most will have persistent symptoms a week after presentation and many will have continued functional impairment months after symptom onset. Physician frustrations are multifaceted – preoccupation for finding the rare dangerous back pain patient (the one with an epidural abscess or vertebral osteomyelitis), difficulty in relieving pain and concern for secondary gain (i.e. opiate abuse or diversion). Post-ED analgesia regimens range from NSAIDs and acetaminophen to muscle relaxants (i.e. cyclobenzaprine) to benzodiazepines and opiates. Previous work from this group demonstrated a lack of benefit for adjunct cyclobenzaprine or oxycodone/acetaminophen to naproxen. Now, they turn their eye to the use of diazepam in addition to naproxen. Read more →

Fluid Responsiveness and the Six Guiding Principles of Fluid Resuscitation

27 Feb
February 27, 2017

Background: Fluid resuscitation is a crucial aspect of emergency and critical care. Since the advent of the concept of early goal-directed therapy, we have placed a huge emphasis on aggressive fluid resuscitation in patients with severe sepsis and septic shock. From EGDT to PROCESS/ARISE/PROMISE to Surviving Sepsis Guidelines, we have seen a shift in how fluid resuscitation is monitored, but the idea of aggressive fluid resuscitation is still the crux of our hemodynamic management of these patients. Yet, the FENICE study showed that in 46 countries, there is a “huge variability in the current practice regarding an FC [fluid challenge]…and may reflect the controversies in current guidelines.” (Cecconi 2015) Read more →

The Good, The Bad, and The Ugly of Proton Pump Inhibitors in UGIB

23 Feb
February 23, 2017

Upper gastrointestinal bleeding remains a common reason for emergency department visits and is a major cause of morbidity, mortality, and medical care costs. Often when these patients arrive, the classic IV-O2-Monitor is initiated and hemodynamic stability is assessed. One of the next steps often performed includes the initiation of proton pump inhibitors (PPIs).

The ultimate question however is does initiation of PPIs reduce clinically relevant outcomes (i.e. mortality, rebleeding, need for surgical intervention) in upper gastrointestinal bleeds (UGIB)? Read more →

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