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.

October 20, 2017

Welcome back to Episode 40 of REBEL Cast. We have taken some time off but don’t worry, we are back.  In this episode, we will be discussing some studies from the past year that caught our attention, dealing with pain control.  With the hundreds of journals in EM/CC and the thousands of publications it is hard to stay up to date with current research. This 3 part series will be dedicated to discussing current literature and how it can be applied to your clinical practice.

August 7, 2017

Background: It has been common practice in trauma to place patients in cervical collars and on long backboards (LBBs) to achieve spinal immobilization. LBBs are used to help prevent spinal movement and facilitate extrication of patients. Cervical collars (C-Collars) are used to help prevent movement of the cervical spine and often are combined with lateral head blocks and straps. The theory behind this is that spine immobilization prevents secondary spinal cord injury during extrication, transport, and evaluation of trauma patients by minimizing movement.  Most of this information has been passed on from historical teachings, like the Advanced Trauma Life Support (ATLS) courses, and not from scientific research. To date there has been no high-quality evidence that use of spinal immobilization improves patient outcomes. In this post, we will review the evidence associated with spinal immobilization in trauma patients.

July 3, 2017

Background: Falls are the most common cause of traumatic mortality in geriatric patients. Each year, about 1/3 of community-dwelling adults over the age of 65 suffer standing-level falls. Over age 80, the incidence rises to nearly half (Carpenter 2014). Of the patients admitted to the hospital for injuries resulting from a fall, 33% will be dead within the year (Masud 2001). The emergency physician is tasked with the rapid evaluation and management of these patients, as well as the simultaneous responsibility of identifying those patients at risk for recurrent fall and intervening on modifiable risk factors. The American Geriatrics Society, Centers for Disease Control, and American College of Emergency Physicians all recommend that acute care providers screen for the risk of recurrent fall.