Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. Additionally, post LP headaches that are left untreated can cause impaired ability to perform activities of daily living and there are case reports of subdural hematoma, herniation, and death. In terms of the prevention and treatment of post-LP headaches, both are equally important in management. Following, is a discussion of which techniques and preventative measures are evidence based and which are not.
Diabetic ketoacidosis (DKA) is a common endocrine emergency encountered in the emergency department. DKA associated mortality is relatively low in adults, but in children with type 1 diabetes, the elderly, and adults with concomitant illnesses have a mortality rate is > 5% (19564476). Guidelines for the management of hyperglycemic crisis in adults provide recommendations for intravenous fluid administration, correction of electrolyte abnormalities, insulin and bicarbonate therapy. While the recommendations made in the American Diabetes Association (ADA) consensus statement are intended to be evidence based, there are two recommendations which have less than optimal supporting evidence which results in controversy in the emergency department: 1. Use of regular insulin boluses of 0.1 units/kg and 2. patients with a pH < 6.9 should receive sodium bicarbonate therapy. Today we will attempt to answer the question, is there any benefit to an initial insulin bolus in DKA?
Preoxygenation and apneic oxygenation are key in emergency airway management, prevention of desaturation, and very important to patient safety. One of the best papers I have ever read on this was written by Scott D. Weingart (@emcrit) and Richard M. Levitan (@airwaycam) in the Annals of Emergency Medicine in March 2012. This article reviewed techniques in preoxygenation and peri-intubation oxygenation in adult patients requiring tracheal intubation. Read more →
This year I was fortunate enough to attend the Social Media And Critical Care (SMACC) conference from Mar 19th – 21st, 2014 at the Gold Coast Australia, also known as SMACCGOLD. SMACC is a modern, academic meeting, mixed with on-line technologies to deliver innovation in education in the fields of emergency medicine and critical care. This conference addresses important clinical issues in a format that is energetic, cutting edge, and yet reputable. So what did I learn? Well, more than I can put into one post, but some of the highlights are listed below. Read more →
I am happy to announce that REBEL Reviews will now be an app by AgileMD, and can be found at REBEL Reviews on AgileMD. REBEL Review cards started as my notes reviewing for board exams and useful clinical content on my rotations as a resident. They had been archived on the blog under REBEL Reviews, but required the internet to access. Now, once downloaded from electronic devices (iPhone/iPad, Android), the cards can be accessed on your mobile device without requiring internet access. The purpose of the cards is to take different board review topics and clinical content, remove the fluff, and consolidate the information into useful high-yield charts. This will remain a FREE resource. Read more →