June 27, 2020

Background: Acute gastrointestinal bleeding (GIB) is a common diagnosis dealt with by emergency clinicians.  Definitive therapy for acute GIB often includes endoscopy or surgery. However, there is a myriad of pharmaceutical options (i.e. PPI, Somatostatin Analogues, Antibiotics, etc.) as well as blood products that may be instituted as part of the acute resuscitation of these patients. The role of tranexamic acid (TXA) in resuscitation of this condition is unknown.

TXA has become one of the darling medications of emergency medicine, with numerous indications, minimal side effect profile and low cost. TXA works by inhibiting blood clot breakdown (i.e. fibrinolysis).  TXA has been shown to decrease death from bleeding in other conditions (Trauma, Postpartum hemorrhage) but there is limited evidence for its use in GIB.  A systematic review and meta-analysis of seven randomized trials with just over 1600 patients [2] showed a reduction in all-cause mortality.  However, the individual trials were small and prone to a myriad of biases making these conclusions hypothesis generating at best.

June 25, 2020

Definition: Suppurative infection enclosed within the epidural space

Epidemiology

  • Incidence: 2-3 cases per 10,000 hospitalized patients (Sendi 2008).
    • Rate is increasing given the rise in number of spinal procedures and anesthesia techniques
  • Mortality is low at 5%, however, if untreated paralysis may occur
  • Can occur at any age but most patients are between 50 and 70 years old.

June 24, 2020

Take Home Points
  • Heat stroke is a life-threatening disorder characterized by elevated core temperature, compromise to neurologic function and multi-system organ dysfunction
  • The keystone of treatment is rapid cooling within 30 minutes of presentation preferably with ice water immersion
  • Patients with heat stroke should be investigated for rhabdomyolysis, AKI, liver failure and concomitant infection

June 23, 2020

Background: We have been in need of a sign of hope in the fight against SARS-CoV-2 as it runs from city to city overwhelming health systems.  The majority of patients will be either asymptomatic or have only mild disease.  These patients will improve for the most part with symptomatic care.  There is a smaller portion of patients admitted to the hospital and ICU requiring oxygen therapy or invasive mechanical ventilation (IMV).  In this group of patients, there has not been much promise in the way of treatments improving mortality.  Patients requiring oxygen therapy (HFNC, NIV, IMV, ECMO) are mostly in the pulmonary and hyperinflammatory stage of disease (see below figure). One theoretical option in this hyperinflammatory stage of disease is corticosteroids to help quell the immune response and potentially improve mortality outcomes.

June 22, 2020

Ear, nose, and throat (ENT) complaints are commonly seen in the emergency department. When you hear “ENT emergencies,” you probably think about epistaxis, sinusitis, and possibly foreign body removal (either from the ear or nose). While not as common, auricular hematomas are equally important to both understand and know how to manage. As a former wrestler, I can attest to the importance of 1) knowing how to accurately diagnose and 2) how to treat this injury to prevent future development of “cauliflower ear”. An auricular hematoma is a collection of blood underneath the perichondrium of the ear that typically occurs secondary to trauma. Common mechanisms of injury include an ear-piercing gone wrong or blunt trauma in contact sports (wrestling, boxing, and martial arts). Inadequate treatment of an auricular hematoma can lead to the development of an auricular deformity commonly known as “cauliflower ear,” which develops from permanent cartilage destruction.