Background: Patients presenting with acute exacerbations of congestive heart failure are frequently treated with intravenous loop diuretics. Despite being treated with loop diuretics, the problem is many are discharged from the hospital with residual clinical signs of volume overload despite …
Background: Coronary artery disease can result in hibernating myocardium (chronic myocardial contractile dysfunction) due to ischemia. The theory is that there is reduced coronary blood flow and increased myocardial demand resulting in impaired contractility. Whether reversal of myocardial hibernation by …
Background: Hypoxemia is a commonly encountered adverse event during rapid sequence intubation (RSI) in the ED. Critically ill patients in the ED often have a lack of physiologic reserve, decreased cardiac output, increased shunting, and reduced pulmonary reserves. Therefore, a …
Background: Hypoxemia and hypoperfusion are important factors in outcomes after ROSC. While hypoxemia (SpO2 <90%) is clearly deleterious, it is unclear if hyperoxia is beneficial. Recent studies on patients requiring critical care have demonstrated that hyperoxia is harmful and instead …
Background: The Calcium for Out-of-Hospital Cardiac Arrest (COCA) trial was a randomized, placebo-controlled, double-blind trial of calcium compared to placebo in OHCA. COCA found no improvement in sustained ROSC but, rather, a trend towards harm for their primary outcome. Additionally, …
Background: The use of ketamine and etomidate for induction in rapid sequence intubation is heavily debated. The Ketased Trial (Jabre 2009) reported no significant difference between the two induction agents. However, recently the National Emergency Airway Registry reported ketamine is …
Background: Traumatic lacerations presenting to the emergency department are, by definition, contaminated (ie non-sterile). Standard management involves irrigation, local anesthesia, closure and tetanus update if required. The existing literature has never shown benefit to sterile gloves in these types of …
The DINAMO Study: Efficacy and Safety of Non-Antibiotic Outpatient Treatment in Mild Acute Diverticulitis James C. Fletcher, MD, FACEP and Nicholas Slattery, MD Background: Diverticulitis is a common finding amongst Emergency Department patients, accounting for more than 360,000 visits in …
Background: The overall mortality and case-fatality rate for pulmonary embolism (PE) are decreasing. Yet reporting is increasing, suggesting we are overdiagnosing PE. Furthermore, management with anticoagulation is not entirely benign and places a potential risk of bleeding upon the patient. …
Background: Some of the feared complications of endotracheal intubation include hypotension, cardiac arrest, and death (cardiovascular collapse). These complications can result from numerous causes including medication-induced vasodilation and decreased venous return to the heart due to increased intrathoracic pressure from …
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