October 29, 2020

Background: ICU discharge is often delayed due to intravenous vasopressor requirements to maintain clinically indicated blood pressure goals. In some patients without impairment of tissue oxygenation, the use of oral agents could facilitate weaning from IV vasopressors and lead to earlier ICU discharge. Midodrine is an oral alpha1 adrenergic agonist that may facilitate liberation from IV vasopressors. Evidence for this is mostly observational without randomized clinical trials (See PulmCrit).

October 28, 2020

Take Home Points
  • Measles is highly infective: One infected person can infect approximately 10-20 unvaccinated people
  • 2 doses of MMR is 97% protective
  • Unvaccinated people can acquire measles from travel to endemic areas with low vaccination rates
  • There is a large amount of misinformation on the internet
  • Misinformation uses fear based messaging and the power of story
  • The evidence is overwhelming > 23,000,000 patients showing no evidence of any link between autism and MMR
  • Anecdotes are not evidence but vulnerable patients may be more susceptible to story then statistics
  • We should add anecdote as a tool to counsel patients

October 26, 2020

Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision.1-4 As with other compartment syndromes, rapidly increasing and sustained high intraocular pressures (IOP) can result in devastating consequences. OCS causes retinal and optic nerve ischemia due to increased pressure on those structures. Due to the time-sensitive nature of this condition, the emergency physician (EP) plays a critical role in the diagnosis and management of OCS.5 The definitive therapy for this condition is lateral canthotomy and inferior cantholysis (LCIC).

October 24, 2020

Background: It almost seems that when it comes to the use of the antifibrinolytic agent tranexamic acid (TXA) in trauma, one argument has just been completed and another one comes up right behind it. Let’s take a step back. Most agree that the evidence clearly supports the role of the early in-hospital administration of TXA in major trauma (in conjunction with balanced blood product transfusion practices). Given the benefit of in-hospital use, and the evidence supporting most benefit with earlier use, it seemed to make intuitive sense to bring this out into the prehospital setting closer to the point-of-injury – many agencies have done just that. However, this particular area of use did not have any associated high-quality evidence. Led by a team out of the University of Pittsburgh (the same group that brought us the PAMPer trial in 2018), Guyette et al just released the Study of Tranexamic Acid During Air Medical and Ground Prehospital Transport (STAAMP) trial, published in JAMA Surgery.

October 22, 2020

Background: Acute gastroenteritis (AGE) is a very common emergency department (ED) presentation, with “approximately 1.5 million pediatric outpatient visits and 200,000 admissions” each year (Benary).   Treatment for AGE is mainly supportive, utilizing rehydration therapy and antiemetic medications.  One common and well studied antiemetic is ondansetron, which has been shown to be effective at controlling vomiting and decreasing hospitalization rates in pediatric patients.  Despite its widespread use within the emergency department, there is significant variation in the use of ondansetron as a discharge prescription, with providers noting the fear of masking a worsening condition or missed diagnosis and thus preventing a necessary return visit.