As emergency physicians, we are constantly on the look out for elevated blood pressures and the potential devastating consequences. We are concerned about intracranial bleeds and acute pulmonary edema from heart failure. But what about the patient that comes in with high blood pressures, yet has no symptoms? Do we need to treat the number or the patient? In this post we will tackle this clinical dilemma of elevated asymptomatic hypertension: To treat or not to treat? Read more →
Animal bites are a common cause of injury in the United States. About 4.5 million Americans/year (5% of all traumatic wounds in the ED) will sustain a bite injury. Dog bites compromise a majority of these wounds. The classic teaching is that dog bites should not be closed primarily and they should all be prophylactically treated with antibiotics. When dog bites become infected, Pasteurella species, specifically P. canis, are the most common pathogens. Amoxicillin-clavulanate (AKA “dog-mentin”) is the antibiotic of choice. It’s also important to keep in mind that Emergency Department repaired lacerations (not just dog bites but all comers) have a 3-7% infection rate. As usual, the dogma (pun intended) is based on minimal if any evidence. Additionally, there are some recent articles that are relevant to the discussion that should be discussed.
Recently, there has been a lot of buzz about the use of topical tranexamic acid for epistaxis or oral bleeds on multiple social media platforms. Everyone seems so happy that it works so well, but we thought we would look through the literature and see what the evidence for use of topical tranexamic acid (TXA) is and how best to compound it for these clinical dilemma. We performed a PubMed, and Ovid search using the terms “topical” AND/OR “oral solution” AND/OR “intranasal” PLUS “tranexamic acid” to answer our questions at hand. Read more →
D-dimer has been shown to increase with age, which can cause a lower specificity (i.e. more false positive tests) in older patients. The result of this would be that older patients would often have more diagnostic imaging or downstream testing, but on the other hand, maybe a higher cut-off d-dimer value may lead to increased false negative cases (i.e. missed venothromboembolism) and make this strategy less safe. Recently, I wrote a post on age-adjusted d-dimer testing on REBEL EM, but since that post there was a new article that was published in Chest 2014. This post, will specifically focus on an update of age-adjusted d-dimer testing based on the above article. Read more →
Welcome to REBELCast Episode 1, where Matt, Swami, and I are going to tackle a couple of scenarios to help your clinical practice. Today, we are going to specifically tackle two different topics:
- Topic #1: Clinically Important Biphasic Anaphylaxis
- Topic #2: Total Lymphocyte Count (TLC) as a Surrogate Marker for CD4 Counts