March 10, 2016

Background: It is well documented that the number of visits to the ED for abscesses is on the rise in the US, with methicillin-resistant Staphylococcus aureus (MRSA) being the most common cause of purulent skin and soft-tissue infections. The primary treatment for cutaneous abscesses is incision and drainage (I&D). The prescription of antibiotics after this procedure is not straightforward. On one hand there is increased cost and possibly increased side effects, but on the other hand maybe antibiotics will increase eradication and improve treatment. What is known is that I&D alone will result in resolution in >80% of cases. So this begs the question, should we be empirically prescribing Trimethoprim-Sulfamethoxazole for uncomplicated skin abscesses after I&D?

February 29, 2016

We are getting closer to the end of the year and pretty soon 3rd year residents will be graduating and moving on to their first jobs as attending physicians.  My own residents have been asking for advice, and I thought this would be a great opportunity to ask some EM educators what their advice would be. Essentially, I asked each of them two basic questions and let them steal the show. For our inaugural first episode I asked Anand Swaminathan if he could give us some of his words of wisdom.

February 24, 2016

Background: Systemic Inflammatory Response Syndrome (SIRS) is something that has been beat into the heads of medical students, residents, fellows, and all physicians in general. However, the derivation of SIRS occurred in 1991, where the focus was on the then-prevailing inflammatory response of the host immune system. In 2001, a task force recognized the limitations of these definitions but did not really offer alternatives due to a lack of supporting evidence. What we have been left with is the definitions of sepsis being largely unchanged for more than 2 decades, until now. Enter Sepsis 3.0.

February 22, 2016

Background: As Emergency Department (ED) physicians it is not uncommon to give patients procedural sedation and analgesia (PSA) to help facilitate painful procedures. Performing PSA requires close monitoring and is not without potential adverse events. There are numerous analgesic, sedative, and anesthetic agents that can be used in combination for PSA in the ED. Adverse event reporting for PSA has been heterogeneous. The purpose of this systematic review and meta-analysis is to determine the incidence of adverse events during PSA in the ED, including the frequency of events with individual drugs and different drug combinations.

February 18, 2016

Chest Pain (CP) is a very common complaint seen in emergency departments around the world.  In the US specifically  anywhere from 8 - 10 million patients present to the ED complaining of CP.  Many use liberal testing strategies to prevent missing acute coronary syndrome (ACS) or other major adverse cardiac events (MACE), but this is not without increase in healthcare cost and false positive testing leading to more downstream testing.  In recent years there have been several diagnostic protocols developed to help determine a portion of these patients as low risk to facilitate early discharge, prevent this over testing, while still having a >99% NPV for MACE at 30 days. Disclaimer: To be clear, this is the way I manage low risk chest pain and certainly there is more than one way, but I think at the current time in the US, this is the best we have.  Also, at the time of this post being written, we DO NOT have high sensitivity troponins in the US.