Contrast Induced Nephropathy (CIN): Fact or Myth?

20 Mar
March 20, 2017

Background: Use of contrast media in CT scans has been cited as one of the most common causes of iatrogenic acute kidney injury.  Its use however improves the diagnostic accuracy of CT scans.  Some studies have even reported an incidence of contrast induced nephropathy (CIN) as high as 14%.  Many of the studies coming to these conclusions were performed before the use of low- and iso-osmolar contrast agents. Also to date, all controlled studies on this topic have been observational and not randomized controlled trials.  More recent propensity-scored analyses have had conflicting results. One study found no increased risk of acute kidney injury, dialysis or mortality regardless of baseline renal function, while others have found increased acute kidney injury in patients with renal dysfunction. This current study tried to clarify the incidence of acute kidney injury attributable to IV contrast media administration. Read more →

Etomidate vs Ketamine in Trauma RSI

16 Mar
March 16, 2017

Background: Etomidate and ketamine are both routinely used as induction agents during rapid sequence intubation (RSI) in trauma patients. It is well established that etomidate transiently suppresses the adrenal gland through inhibition of the 11-beta hydroxylase enzyme. Though adrenal suppression in theory can cause deleterious outcomes, there is no high-quality evidence demonstrating a change in patient centered outcomes with it’s use in comparison to alternate agents. Ketamine has long been an alternative induction agent to etomidate but historical concerns, though disproven in more recent literature, limited it’s use due to concerns over increasing intracranial pressure. Read more →

The Benefit of Lung Protective Ventilation in the ED Should be LOV-ED

13 Mar
March 13, 2017

Background: Intubation and mechanical ventilation are commonly performed ED interventions and although patients optimally go to an ICU level of care afterwards, many of them remain in the ED for prolonged periods of time. It is widely accepted that the utilization of lung protective ventilation reduces ventilator-associated complications, including acute respiratory distress syndrome (ARDS). Additionally, it is believed that ventilatory-associated lung injury can occur early after the initiation of mechanical ventilation thus making ED management vital in preventing this disorder. Despite this, intubated ED patients are not optimally ventilated used lung-protective strategy on a routine basis. Read more →

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 →

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