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.

March 16, 2017

Background: Etomidate and ketamine are both routinely used as induction agents during rapid sequence intubation (RSI) in trauma patients. It is well established that etomidate transiently suppresses the adrenal gland through inhibition of the 11-beta hydroxylase enzyme. Though adrenal suppression in theory can cause deleterious outcomes, there is no high-quality evidence demonstrating a change in patient centered outcomes with it’s use in comparison to alternate agents. Ketamine has long been an alternative induction agent to etomidate but historical concerns, though disproven in more recent literature, limited it’s use due to concerns over increasing intracranial pressure.

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.

January 19, 2017

Background: Ketorolac is a commonly used parenteral analgesic in the Emergency Department (ED) for a variety of indications ranging from musculoskeletal injuries to renal colic. This non steroidal anti-inflammatory drug (NSAID) is available in oral, intranasal and parenteral routes. Ketorolac has a number of side effects including nausea, vomiting, gastrointestinal bleeding and renal insufficiency. The risk of GI bleeding appears to be related to the use of higher doses and prolonged use. As with all NSAIDs, the drug has an analgesic ceiling - the dose at which additional dosing will not provide additional analgesia but can lead to more side effects. The current FDA dosing is 30 mg intravenously and 60 mg intramuscularly for patients < 65 years of age. However, the necessity of these doses is unclear and prior studies have demonstrated efficacy of considerably lower doses. The use of lower doses, if effective, may mitigate the potential for harm.

October 20, 2016

This years ACEP 2016 conference took place in Las Vegas, NV from Oct 16th - 19th.  There was greater than 350 courses, labs, and workshops given throughout the week.  It was impossible to make all of these great lectures, but I was able to take away some very important clinical pearls that I wanted to share with our readers.