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    Approximately 1 in 3 computed tomography (CT) scans performed for head injury may be avoidable. We evaluate the association of implementation of the Canadian CT Head Rule on head CT imaging in community emergency departments (EDs). [...]

    Authors screened 670 abstracts and selected 117 for full-text review, of which 11 met inclusion criteria. A total of 4,769 patients were included, of whom 2,345 had serologically confirmed mononucleosis. Three studies were prospective cohort studies, 3 were retrospective laboratory studies without clinical information, and 5 were case series with confirmed mononucleosis. Of the studied elements, atypical lymphocytes had the greatest positive LR (Table). None of the examined elements were sufficient to exclude the diagnosis. [...]

    The authors included 11 studies, with 10 randomized controlled trials and 1 observational longitudinal study for analysis, with 1,633 patients. Ten of the 11 articles were predominantly pediatric, although a single study accounting for more than half the patients analyzed in the meta-analysis (893 patients) comprised both children and adults with mean age 43 years among patients receiving benzodiazepines by alternative routes and 44 years in the intravenous group.2 Comparison of failure, defined by failure to stop seizure, favored benzodiazepines administered by alternative routes (odds ratio 0.72; 95% CI 0.56 to 0.92). [...]

    In the systematic review, 19,998 patients were included from 6 randomized trials (n=4,342) and 31 observational studies (n=15,656). The pooled analysis demonstrated a 23% reduction in the risk of mortality in patients treated with early goal-directed therapy (relative risk=0.77; 95% confidence interval 0.71 to 0.83; P [...]

    Much effort has been expended to understand what care experiences patients value in the emergency department (ED), yet little is known about which outcomes patients value after ED care. Our goal is to define outcomes of ED care that are valued by patients discharged from the ED, with the goal of informing the development of a patient-reported outcome measure for ED care. [...]

    Electronic health record implementation can improve care, but may also adversely affect emergency department (ED) efficiency. We examine how a custom, ED provider, electronic documentation system (eDoc), which replaced paper documentation, affects operational performance. [...]

    Transgender, gender-variant, and intersex (trans) people have decreased access to care and poorer health outcomes compared with the general population. Little has been studied and documented about such patients’ emergency department (ED) experiences and barriers to care. Using survey and qualitative research methods, this study aims to identify specific areas for improvement and generate testable hypotheses about the barriers and challenges for trans individuals needing acute care. [...]

    We conduct a systematic review and meta-analysis to evaluate the effectiveness of apneic oxygenation during emergency intubation. [...]

    A total of 3,193 separate articles were identified by the searches; 28 were selected for closer review and 10 articles were included in the final review, 1 retrospective case-control study, 7 retrospective cohort studies, and 2 prospective cohort studies, all from January 2003 to September 2015. Pooled data resulted in 2,966 patients with 553 traumatic intracranial hemorrhages (19%) in the combined antiplatelet group and 18,281 total patients with 1,422 (8%) traumatic intracranial hemorrhages in the combined control group. [...]

    Authors included 22 studies in the network meta-analysis, excluding 11 from the 2015 Cochrane review. Hydrocortisone infusion demonstrated superior shock reversal compared with placebo (OR 3.68; 95% CI 1.52 to 8.93) (Table). Methylprednisolone bolus was less likely to reverse shock than hydrocortisone bolus (OR 0.37; 95% CI 0.19 to 0.72). No regimens demonstrated superiority for the outcomes of mortality at 28 days, hospital mortality, ICU mortality, or incidence of superinfection. Methylprednisolone use trended toward increased mortality compared with dexamethasone (OR 5.71; 95% CI 0.99 to 32.9). [...]

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    iSepsis; Vitamin C, Hydrocortisone and Thiamine - Q&A EMCrit by Paul Marik. [...]

    Recently a few cases at Genius General have arisen where cvO2% was misleading.  Specifically, the cvO2% was elevated despite cardiogenic or hemorrhagic shock.  This post will attempt to explore why this might occur. EMCrit by Josh Farkas. [...]

    Vitamin C, Hydrocortisone and Thiamine for sepsis EMCrit by Paul Marik. [...]

    iSepsis - The Metabolic Resuscitation Protocol EMCrit by Paul Marik. [...]

    some physio behind the IVC debate EMCrit by Guest Author. [...]

    Anyone who has spent some time in a cardiac intensive care unit understands the physiologic appeal of the intra-aortic balloon pump (IABP). Anecdotally its use improves multiple clinical endpoints that for years have been considered surrogates for patient important outcomes. And yet, despite these physiologic advantages when examined in a rigorous fashion, IABPs have failed […] EMCrit by Rory Spiegel. [...]

    New agents for Reversal of NOACS EMCrit by Scott Weingart. [...]

    a wee bit more EMCrit by Scott Weingart. [...]

    iSepsis - Vena Caval Ultrasonography is useless for assessing volume status. EMCrit by Paul Marik. [...]

    As a medical student I rotated through an elite hospital where it was believed that every patient admitted to the medicine service needed a rectal exam.  The rationale was to avoid ever missing a case of rectal or prostate cancer.  Eventually, the utility of digital rectal examination as a cancer-screening tool was debunked.  Thankfully, this practice has fallen out of favor. EMCrit by Josh Farkas. [...]

    ercast.org Peeing Blood and the Pesky Erection Emergency management of priapism, hematuria, and interstitial cystitis are discussed with urologist Brian Shaffer. Warning: the following program contains graphic descriptions of medical procedures. Listener discretion is advised. http://traffic.libsyn.com/ercast/bloody_urine_and_the_pesky_erection_ercast.output.mp3 Direct Download Stuff Adam and Rob have discovered recently and are really digging Rob Dermastent Bounce Bars esp the Cacao Mint. Super tasty and efficient nutrition balls […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org When Breath Becomes Air. Lucy Kalanithi Interview Last summer I took a road trip to Canada and during the drive I listened to the book When Breath Becomes Air. That was a year ago, and I still think about that book, almost daily. When Breath Becomes Air is the autobiographical account of the final 2 years of neurosurgeon Paul Kalanithi life. Paul […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org Spring 2017 Journal Club It may be summer (in the northern hemisphere), but that doesn’t mean we can talk all the goodness that was our spring journal club. As usual, Adam Rowh slayed the beer selection with a killer Scottish ale as well as these lovely articles. Enjoy…. http://traffic.libsyn.com/ercast/Spring_Journal_Club_2017.mp3 Direct Download The papers Less is more for low back […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org How to learn from a lecture Amal Mattu stops by to talk about the best way to get the most from attending (as well as giving) a lecture. Hint, it’s not the the transfer of information. Amal says that lectures have one of two purposes: to persuade or  inspire. http://traffic.libsyn.com/ercast/How_to_learn_at_a_conference.output.mp3 Direct Download   To get the most out of attending a […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org Examining mental health patients When you examine a patient who presents with a mental health complaint, let’s say they are depressed and psychotic, how do you do it? Do you listen to their lungs and heart, check for pitting edema? You might, if the history dictates. We are also responsible for a medical screening exam, but regarding the focused mental […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org Nasal suction. Miraculous simplicity It is bronchiolitis season my friends. Even I have a bit of the URI. When we’re talking bronchiolitis, the conversation is almost always about: do steroids or bronchodilators work, what to do with a touch of hypoxia. Important conversations to be sure, but the highest yield pearl I have ever received about bronchiolitis (or any […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org Articles you need to know – winter edition There’s a journal club in my living room every few months (or at least there will be – this was the first). Raconteur Adam Rowh, MD joins the show to talk the med lit we dissected by the fireside. http://traffic.libsyn.com/ercast/Articles_you_need_to_know_-_winter_edition.mp3 Direct Download Stuff in this show Prandoni, Paolo, et al. “Prevalence of pulmonary embolism among […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org Mumps It’s time for a mumps outbreak! Here is a basic primer on the very basic basics. http://traffic.libsyn.com/ercast/Mumps_ERCast.output.mp3 Direct Download   How do you get mumps?  Respiratory secretions, that guy sitting next to you on the airplane with the huge parotid gland and just sneeze in your eye. Not good. Incubation period How long does this […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org Practice Changers What were your practice changers in 2016? For me, it was Reuben Strayer’s simple phrase for when to give epinephrine in allergic reaction patients: For A, B, or C,  give E. If there is involvement of airway, breathing, or circulation, give epi. It seems simple when it’s spelled out this way, but there can be […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    ercast.org SassyMD If you are on Twitter, there’s a good chance you’ve seen commentary from our guest today Sassy MD. She is a 4th year medical student and gives an unfiltered commentary on the trials and tribulations of med school, life, deciding what shoes to wear, and even the internal dialogue about her attendings. http://traffic.libsyn.com/ercast/Sassy_MD.mp3 Direct Download […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine residents. It was a particularly competitive year for Emergency Medicine, with 99.7% of first-year spots filled despite a whopping 2,047 positions being offered in 2017 (up by 152 spots compared to last year).1 Now begins [...] The post ALiEM’s Greatest Hits for Interns: A Curated Collection of High-Yield Topics appeared first on ALiEM. [...]

    Pelvic trauma frequently is associated with other injuries from the high force required to break the pelvis. Management is focused on stabilizing the pelvis and stopping the bleeding. Due to other injuries requiring emergent surgical stabilization, pelvic trauma is primarily managed surgically with pre-peritoneal packing and external fixation, followed by angioembolization for continued bleeding. Emergency [...] The post Management of Major Pelvic Trauma appeared first on ALiEM. [...]

    After a STEMI activation from the field on Monday morning, the cardiac catheterization team scoops the patient away shortly after the paramedics arrive in the Emergency Department (ED). “Well that was a smooth and seamless resuscitation. The patient was barely in the ED for more than 15 minutes,” you think to yourself. You diligently complete [...] The post ED Charting and Coding: Critical Care Time appeared first on ALiEM. [...]

    Our final case of this season, The Case of the Competency Conundrum, outlined a scenario of residency competency committee members who are divided in their approach to a superstar R4 resident, Josh, who has already completed the requirements of his training program. They struggle with competing opinions surrounding competency based medical education (CBME) early advancement principles [...] The post MEdIC Series: Case of the Competency Conundrum – Expert Review and Curated Community Commentary appeared first on ALiEM. [...]

    Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. In this case, a 53-year-old man with history of diabetes mellitus presents with right [...] The post Ultrasound for the Win! 53M with Right Index Finger Swelling #US4TW appeared first on ALiEM. [...]

    A patient is brought to the Emergency Department by EMS (Emergency Medical Services) from a house fire. The patient’s skin and urine are discolored as shown. What is the most likely cause of the discoloration? Acute liver failure An antidote administered by prehospital provider Carbon monoxide poisoning Massive hemolysis Hydroxocobalamin Hydroxocobalamin often used by [...] The post ACMT Toxicology Visual Pearls: Discolored Skin and Urine appeared first on ALiEM. [...]

    Dr. Rob Orman is an emergency physician from Bend, Oregon. When he’s not in the ED, he can be found creating and working on podcasts for the EM:RAP series, for which he is the Executive Editor. From using mindfulness techniques to stay active, Dr. Orman ensures he is mentally in check at the start of each [...] The post I am Dr. Rob Orman, Executive Editor of EM:RAP: How I Stay Healthy in EM appeared first on ALiEM. [...]

    The above question is common from patients with a history of an allergic reaction seen for a repeat emergency department visit. The manufacturers of EpiPen caution not to use the pen beyond the expiration date, and if the drug solution becomes discolored (oxidation). But EpiPens are expensive! Is there harm in using the pen beyond [...] The post My EpiPen expired! Can I still use it? appeared first on ALiEM. [...]

    Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up glucose from the blood stream, inhibits liver glucose production, increases glycogen storage, and increases lipid production. When insulin is not present, such as in patients with Type 1 diabetes [...] The post PEM Pearls: Treatment of Pediatric Diabetic Ketoacidosis and the Two-Bag Method appeared first on ALiEM. [...]

    Dr. Richard Shoemaker is an emergency physician from Philadelphia. Primarily working overnight shifts in the ED, Dr. Shoemaker has learned how to master the “shift world”. He maintains his fitness by training as an American Ninja Warrior and is an avid rock climber. Here’s how he stays heathy in EM!   Name: Richard Shoemaker, MD Location: [...] The post I am Dr. Richard Shoemaker, Emergency Physician and American Ninja Warrior: How I Stay Healthy in EM appeared first on ALiEM. [...]

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    From the recent medical literature...1. On Hemorrhaging in Pts on DabigatranA. Idarucizumab for Dabigatran Reversal - Full Cohort Analysis.Pollack CV Jr, et al. N Engl J Med. 2017 Jul 11 [Epub ahead of print].IntroductionPatients who are receiving oral anticoagulant therapy for the prevention or treatment of thrombosis may benefit from anticoagulant reversal if they present with life-threatening bleeding or if they will be undergoing urgent surgery or intervention. Therefore, the availability of specific reversal agents has the potential to improve the benefit–risk profile of long-term anticoagulant therapy and to increase patient and physician acceptance of such treatment. Idarucizumab is a humanized monoclonal antibody fragment that binds dabigatran with high affinity and specificity and rapidly reverses its anticoagulant activity.1 Idarucizumab has been licensed in many countries, in part on the basis of the results of an interim analysis of data on the first 90 patients enrolled in [...]

    From the recent medical literature... 1. Effect of Cephalexin plus TMP-SMX vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A RCTMoran GJ, et al. JAMA. 2017 May 23;317(20):2088-2096. Key PointsQuestion  Does cephalexin plus trimethoprim-sulfamethoxazole yield higher clinical cure rates than cephalexin alone for treatment of patients with uncomplicated cellulitis?Findings  In this randomized clinical trial of 500 patients with cellulitis, the clinical cure rate was not significantly different between those treated with cephalexin plus trimethoprim-sulfamethoxazole vs cephalexin plus placebo (83.5% vs 85.5% in the per-protocol analysis and 76.2% vs 69.0% in the modified intention-to-treat analysis). However, the 95% confidence interval for the difference in the intention-to-treat analysis was −1.0% to +15.5%, which included the minimal clinically important difference of 10%.Meaning  Addition of trimethoprim-sulfamethoxazole to cephalexin did not result in a statistically [...]

    From the recent literature...1. Recent PE ResearchA. PE and DVT in Pts Hospitalized With Syncope: A Multicenter Cross-sectional Study in Toronto, Ontario, CanadaVerma AA, et al. JAMA Intern Med. Published online May 8, 2017. This study is a response to Prandoni et al. NEJM 2017 here: https://www.ncbi.nlm.nih.gov/pubmed/27797317The prevalence of pulmonary embolism (PE) among patients hospitalized with syncope is uncertain. The recently published Pulmonary Embolism in Syncope Italian Trial (PESIT)1 systematically evaluated patients hospitalized with a first episode of syncope and determined that 17.3% had a PE. It is not known how commonly patients hospitalized with syncope are investigated for PE or deep venous thrombosis (DVT) in routine practice.Methods | We conducted a retrospective cross-sectional study at 4 hospital sites in Toronto, Ontario, Canada, that were participating in the General Medicine Inpatient (GEMINI) cohort study. The GEMINI study has linked electronic clinical data [...]

    From the recent medical literature...0. The Science of Humor Is No Laughing Matter (in honor of April Fools’ Day)Alexandra Michel. Observer, April 2017, from the Association for Psychological Science In 1957, the BBC aired a short documentary about a mild winter leading to a bumper Swiss spaghetti crop in the town of Ticino. In a dry, distinguished tone, BBC broadcaster Richard Dimbleby narrates how even in the last few weeks of March, the spaghetti farmers worry about a late frost, which might not destroy the pasta crop but could damage the flavor and hurt prices. The narration accompanies film footage of a rural family harvesting long spaghetti noodles from trees and laying them out to dry “in the warm Alpine sun.”Naturally, the hundreds of people who called the BBC asking where they could get their own spaghetti bushes hadn’t noticed the air date of the news clip: April 1st. The prank was so successful that even some BBC staff were taken in, leading to some criticism about using a s [...]

    Lit Bits: March 18, 2017From the recent medical literature...1. Prospective and Explicit Clinical Validation of the Ottawa HF Risk Scale, with and without Use of Quantitative NT-proBNP.Stiell IG, et al. Acad Emerg Med. 2017 Mar;24(3):316-327OBJECTIVES: We previously developed the Ottawa Heart Failure Risk Scale (OHFRS) to assist with disposition decisions for acute heart failure patients in the emergency department (ED). We sought to prospectively evaluate the accuracy, acceptability, and potential impact of OHFRS.METHODS: This prospective observational cohort study was conducted at six tertiary hospital EDs. Patients with acute heart failure were evaluated by ED physicians for the 10 OHFRS criteria and then followed for 30 days. Quantitative NT-proBNP was measured where feasible. Serious adverse event (SAE) was defined as death within 30 days, admission to monitored unit, intubation, noninvasive ventilation, myocardial infarction, or relapse resulting in hospital admission within 14 days.RESULTS: We enrolled [...]

    From the recent medical literature...0. Kids with Blunt Head TraumaA. The PECARN TBI rules do not apply to abusive head trauma.Magana JN, et al. Acad Emerg Med. 2016 Dec 31 [Epub ahead of print]The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prediction rules were developed to identify children at very low risk for clinically-important TBIs (ciTBIs), for whom computed tomography (CT) scans can typically be obviated.1 The PECARN prediction rules have been validated in several settings and countries.2-5 The PECARN TBI rules, one developed for children younger than 2 years, and the other for those 2 years and older, rely on accurate patient history and physical examination findings gathered at the time of emergency department (ED) presentation.B. Which Children with Mild Head Trauma and Intracranial Injury Need the ICU?Greenberg JK, et al. JAMA Pediatr. 2017 Feb 13 [Epub ahead of print]Key Points Question: Can routine clinical and imaging variabl [...]

    From the recent medical literature...-1. BMJ on New Year’s ResolutionsSixty seconds on . . . New Year resolutions.Hawkes N. BMJ 2016;355:i6845 Made any New Year resolutions? Not really. I follow Oscar Wilde: “Their origin is pure vanity. Their result is absolutely nil.” Bit harsh, surely? Possibly, but the psychological literature isn’t terribly encouraging. One study showed that 22% of people who made them admitted failure after only a week, 40% at a month, 50% at three months, and 81% after two years. Most likely the real figures were even higher, because these were self reported.1 Yet people still make resolutions They do. The change of year seems to offer a chance to change lifestyle as well as date. Giving up smoking, losing weight, or drinking less are the commonest. Among students, resolving to work harder is common. And they all come to naught? Not entirely. People can change, though it’s hard. Even if only a small proportion succeed, that’s better than nothing. The psychologic [...]

    From the recent medical literature...0. Light-hearted Studies from the 2016 BMJ Christmas IssueA. Gotta catch’em all! Pokémon GO and physical activity among young adults: difference in differences studyConclusions: Pokémon GO was associated with an increase in the daily number of steps after installation of the game. The association was, however, moderate and no longer observed after six weeks.Full-text (free): http://www.bmj.com/content/355/bmj.i6270B. Do celebrity endorsements matter? Observational study of BRCA gene testing and mastectomy rates after Angelina Jolie’s New York Times editorialConclusions: Celebrity endorsements can have a large and immediate effect on use of health services. Such announcements can be a low cost means of reaching a broad audience quickly, but they may not effectively target the subpopulations that are most at risk for the relevant underlying condition.Full-text (free): http://www.bmj.com/content/355/bmj.i6357C. Dispelling the nice or naughty myth: retr [...]

    From the recent literature...1. The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in ED Patients with UGI Bleeding: None Ready for Prime TimeRamaekers R, et al. Acad Emerg Med. 2016;23(11): 1218–1227OBJECTIVES: Risk stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using preendoscopic risk scores can aid ED physicians in disposition decision-making. We conducted a systematic review to assess the predictive value of preendoscopic risk scores for 30-day serious adverse events.METHODS: We searched MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating preendoscopic risk scores and excluded reviews, case reports, and animal studies. The composite outcome included 30-day mortality, recurrent bleeding, and need for intervention. In two phases (screening and full review), two reviewers independently screened [...]

    From the recent medical literature...1. High Prevalence of PE among Patients Hospitalized for Syncope: Really?Prandoni P, et al. for the PESIT Investigators. N Engl J Med 2016; 375:1524-1531BACKGROUNDThe prevalence of pulmonary embolism among patients hospitalized for syncope is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients.METHODSWe performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative d-dimer assay. In all other patients, computed tomographic pulmonary angiography or ventilation–perfusion lung scanning was performed.RESULTSA total of 560 patients (mean age, 76 years) were [...]

    PCL injuries can sometimes have involvement of the posterolateral corner (PLC) The dial test can be used to diagnose posterior lateral i... Click to view the rest [...]

    Ventricular shunt (VP) malfunction can be severe and life-threatening and evaluation has typically included a dry CT brain and a shunt se... Click to view the rest [...]

    Vaginal douching is a common and potentially dangerous practice. Women engage in this practice predominately for personal hygiene reasons but... Click to view the rest [...]

    When surveyed, half of general medicine patients interviewed stated that they would prefer to have a loved one present if they were to de... Click to view the rest [...]

    Take Home Points: A radial head subluxation that is common in 1-3 year olds Often secondary to a longitudinal traction on a... Click to view the rest [...]

    Hydrogen peroxide (H2O2) is a common household liquid that is used for wound irrigation/antiseptic and cosmetic purposes. The concentration of... Click to view the rest [...]

    50 YOF with acute onset of worst headache of life associated with nausea and vomiting.  Patient is somnolent, will rouse to noxious stimu... Click to view the rest [...]

    Idiopathic osteonecrosis of the femoral head Children as young as 2 or as old as 12 but generally 4 to 8 (worse in older children) ... Click to view the rest [...]

    Serious outcomes after overdose or nonintentional exposures to medications used to treat depression have risen dramatically over the past 15... Click to view the rest [...]

    Cholera is an acute diarrheal disease that can kill within hours if left untreated. Rising cholera, diarrhea and malnutrition is a dead... Click to view the rest [...]

    Acute gastrointestinal disorders are some of the most frequent problems evaluated by ED physicians.  Complaints of diarrhea account for almost 5% of visits to the emergency departments (Bitterman, 1988).  Although the disease entity is extremely prevalent and current evidence on the … Continue reading → [...]

    1. When do you send stool cultures, stool ovum and parasites, and/or fecal WBC? How do you use the results in diagnosis and management? 2. When do you get bloodwork? When do you pursue imaging? 3. Which patients do you treat with antibiotics? 4. What other … Continue reading → [...]

    1. When do you use NIPPV in status asthmaticus? The use of NIPPV (non-invasive positive pressure ventilation) for respiratory failure has been proven to be beneficial and widely accepted in practice for multiple indications including COPD exacerbations and pulmonary edema … Continue reading → [...]

    1. When do you use non-invasive positive pressure ventilation (NPPV) in status asthmaticus? 2. Do you start inhaled corticosteroids on asthma patients who are going to be discharged from the ED? 3. When, if ever, do you use ketamine for induction, or for … Continue reading → [...]

    In which patients with syncope do you get a NCHCT? Syncope is defined as a transient loss of consciousness and postural tone. It has a rapid onset, short duration, spontaneous recovery and is due to transient global cerebral hypoperfusion. It … Continue reading → [...]

    1. In which patients presenting with syncope do you get a Non-Contrast Head CT (NCHCT)? 2. In which patients presenting with syncope do you get a troponin? 3. Do you get orthostatic vital sign measurements in patients presenting with syncope? How do you … Continue reading → [...]

    1. What imaging do you use for patients with possible acute, traumatic spinal cord injury? Patients who can be cleared using the Nexus or Canadian C-spine criteria should be cleared clinically. However, those with moderate to high risk of a … Continue reading → [...]

    1. What imaging do you use for patients with possible acute, traumatic spinal cord injury? 2. How do you treat neurogenic shock? 3. What is your management and disposition for elderly patients with vertebral compression fractures? 4. How do you … Continue reading → [...]

    1. Which patients with neutropenic fever do you consider for outpatient management? Neutropenic fever is a common presentation to the Emergency Department, especially in tertiary hospitals where many oncology patients are undergoing chemotherapy. According to the Infectious Disease Society of … Continue reading → [...]

      1. Which patients with neutropenic fever do you consider for outpatient management? 2. Which patients with community-acquired pneumonia do you admit? 3. Which patients with influenza do you treat with oseltamivir? 4. Which adult patients getting worked up for a … Continue reading → [...]