June 13, 2018

Background: The provision of safe and judicious analgesia is an important task for the emergency physician. Recent literature has demonstrated the effectiveness of sub-dissociative ketamine (SDK) in the emergency department (ED) setting (Motov 2015), however concerns regarding increased rates of hemodynamic and psychoperceptual adverse effects have limited application of this analgesic strategy in older populations. As awareness of geriatric oligo-analgesia has risen along with efforts to limit opioid utilization, interest in identifying a data set specific to this population has grown. The authors of this study sought to distinguish the performance and shortcomings of SDK in this unique patient group.

June 5, 2018

Background: I received a text message from one of my colleagues inquiring about discharging a patient home with isolated traumatic subarachnoid hemorrhage and to be honest I had heard about this practice, but was not completely aware of the literature around it.  Turns out from a PubMed search there was a meta-analysis published just this past year trying to answer this very question.  When I was a resident, which is not that long ago, the standard practice was for patients to be assessed by neurosurgery for management which usually involved ICU admission or a trip to the OR with ICU admission. Isolated traumatic subarachnoid hemorrhage (itSAH) is typically defined as the presence of a SAH in the absence of any other traumatic radiographic intracranial pathology.  So the question is, is it safe to discharge patients home with itSAH?

May 28, 2018

Background: Patients with penetrating neck trauma can present with a variety of injury patterns including hemorrhagic shock, airway obstruction and neurologic injury. Serious injuries may not be clinically obvious making diagnosis and prompt treatment challenging. Due to the large number of critical structures in the neck, a clear knowledge of the anatomy is necessary for proper evaluation and management.

Epidemiology (Evans 2018)

  • Represent 1% of all trauma admissions in the US and have a 5% mortality rate
  • 80% of morality secondary to cerebral infarction
  • ~ 20% of mortality secondary to uncontrolled hemorrhage

January 8, 2018

Background: In the United States we are not only seeing an opioid epidemic but also a shortage of IV opioid agents. For both reasons, it is important to find non-opioid options for common pain complaints seen in the ED.  Changing prescribing practices is difficult but an important step in minimizing opioid usage.  Current research suggests that even short term opioid use can cause a predisposition to subsequent opioid dependence. In the spirit of doing no harm, we as a healthcare community should look to find other less harmful ways to decrease pain and suffering.  In this episode, we will review four randomized clinical trials published in the past year on pain control to see if there is evidence to support other non-opioid options.

November 20, 2017

Background: Bleeding from massive hemorrhage in trauma and post-partum are a major cause of death worldwide. There have been two large randomized controlled trials, in trauma and post-partum hemorrhage that have shown administration of TXA within 3 hrs of bleeding onset reduces death due to bleeding. The current meta-analysis that we are going to best panerai replica review sought to quantify the effect of treatment delay in acute severe bleeding by analyzing individual patient-level data from the two randomized clinical trials mentioned above.