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Episode 35 – Non Operative Treatment of Appendicitis (NOTA)

Background: Historically the treatment of uncomplicated appendicitis has been appendectomy. The first appendectomy performed dates back to 1735 done by Claudius Amyand. Appendectomy has been the standard treatment for acute appendicitis every since Charles McBurney described it in 1889. However, studies have shown ...

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Infectious Disease

Diabetic Gastroparesis Needs HUGS

Background: Anyone practicing in emergency medicine has taken care of a patient with diabetic gastroparesis.  Although, it is not a sexy topic to discuss, nor a disease process associated with significant mortality, it is associated with decreased quality of life, ...

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Endocrine, Metabolic, Fluid, and Electrolytes

Is Fever the New Hotness in Sepsis?

Background: With the introduction of sepsis 3.0, came the quick sepsis related organ failure assessment (qSOFA) score. The purpose of this score is supposed to be a bedside tool to help predict which patients are at the greatest risk of ...

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Infectious Disease

Altitude Adjusted PERC Oxygen Saturation

The PERC rule has been a welcome addition to the emergency department evaluation of patients with chest pain or dyspnea suspected of pulmonary embolism. This has allowed a reduction in D-dimer testing in low risk patients. The traditional saturation cut-off of ...

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Thoracic and Respiratory

The AMACING Trial: Prehydration to Prevent Contrast Induced Nephropathy (CIN)?

Background: In patients with compromised renal function, the use of intravascular iodinated contrast material is generally not given to avoid contrast induced nephropathy (CIN). Currently, there is no treatment for contrast-induced nephropathy, therefore the focus has been on prevention. Guidelines ...

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Allergy and ImmunologyRenal and Genitourinary

Episode 34 – The Death of Mechanical CPR (mCPR)?

Background: The two most important things that we can do in cardiac arrest to improve survival and neurologically intact outcomes is high quality CPR, with limited interruptions and early defibrillation. In the case of the former, the 2015 AHA/ACC CPR updates ...

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Resuscitation

Contrast Induced Nephropathy (CIN): Fact or Myth?

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 ...

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Allergy and ImmunologyRenal and Genitourinary

Etomidate vs Ketamine in Trauma RSI

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 ...

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Trauma

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

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 ...

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Thoracic and Respiratory

Triage ECGs: Reducing Interruptions in a Busy ED

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 ...

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Cardiovascular
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