March 13, 2017

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 utilization of lung protective ventilation reduces ventilator-associated complications, including acute respiratory distress syndrome (ARDS). Additionally, it is believed that ventilatory-associated lung injury can occur early after the initiation of mechanical ventilation thus making ED management vital in preventing this disorder. Despite this, intubated ED patients are not optimally ventilated used lung-protective strategy on a routine basis.

March 9, 2017

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 medical errors, which affects the patients in front of us.  On the other hand, it is important to avoid delays in care and, in accordance with the American Heart Association guidelines, ECGs in triage should be obtained and interpreted by an attending emergency physician within 10 minutes of arrival to the emergency department for any patients with concerns of acute coronary syndrome. Is there a way to maybe minimize the number of interruptions?

March 6, 2017

Pediatric Septic Hip Definition: Bacterial infection of the hip joint space and synovial fluid

Background:

  • Causes
    • Hematogenous spread in bacteremia
    • Local spread (i.e. from osteomyelitis)
    • Direct inoculation (traumatic or surgical)
  • High-Risk Subgroups
    • Age < 2 years (peak incidence 6 - 24 months)
    • Immunocompromised state (i.e. AIDS, active cancer, etc)
    • Functional asplenia (i.e. sickle cell disease)
  • Complications
    • Sepsis
    • Osteomyelitis
    • Chronic arthritis
    • Osteonecrosis
    • Capsule damage

March 2, 2017

Background: Low back pain is an extremely common presentation to US Emergency Departments (EDs) representing 2.4% or 2.7 million visits annually. The vast majority of presentations are benign in etiology but can be time consuming and frustrating for both patients and physicians. For patients, most will have persistent symptoms a week after presentation and many will have continued functional impairment months after symptom onset. Physician frustrations are multifaceted - preoccupation for finding the rare dangerous back pain patient (the one with an epidural abscess or vertebral osteomyelitis), difficulty in relieving pain and concern for secondary gain (i.e. opiate abuse or diversion). Post-ED analgesia regimens range from NSAIDs and acetaminophen to muscle relaxants (i.e. cyclobenzaprine) to benzodiazepines and opiates. Previous work from this group demonstrated a lack of benefit for adjunct cyclobenzaprine or oxycodone/acetaminophen to naproxen. Now, they turn their eye to the use of diazepam in addition to naproxen.

REBEL Review 79: Treatment of Hemophilia

Created February 28, 2017 | Hematology and Oncology | DOWNLOAD