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    We characterize hospital admissions among older adults for any cause in the 30 days after a significant natural disaster in the United States. The main outcome was all-cause hospital admissions in the 30 days after natural disaster. Separate analyses were conducted to examine all-cause hospital admissions excluding the 72 hours after the disaster, ICU admissions, all-cause inhospital mortality, and admissions by state. [...]

    We describe current hospital-level performance for the Centers for Medicare & Medicaid Services’ Severe Sepsis/Septic Shock Early Management Bundle (SEP-1) quality measure and qualitatively assess emergency department (ED) sepsis quality improvement best practice implementation. [...]

    Many clinical research studies involve paired outcome data, which consist of 2 measurements of the same variable in the same patient at 2 times. This article examines ways that researchers can graphically report data from such studies, meeting the dual goals of showing the experience of each patient while comparing differences between treatment groups. I emphasize the importance of hybrid parallel line plots, examine several useful variations of them, and provide Stata code to make them. [...]

    We undertake this study to understand patterns of pediatric asthma-related acute care use to inform interventions aimed at reducing potentially avoidable hospitalizations. [...]

    The authors included 64 randomized controlled trials reporting outcomes for 7,044 subjects. Only 3 of these studies included patients requiring emergency airway management: one based in an ICU,5 one in a trauma center,6 and one in an out-of-hospital setting.7 The small number of emergency intubations identified precluded subgroup analysis of this population. The remaining 61 studies took place in an operating room setting and comprised elective surgical participants. The most commonly studied video laryngoscopy devices included GlideScope (Verathon, Bothwell, WA) (29 studies), Pentax AWS (Ambu Inc, Ballerup, Denmark) (20 studies), C-MAC (Karl Storz GmbH & Co KG, Tuttlingen, Germany) (9 studies), and McGrath (Aircraft Medical Limited, Edinburgh, UK) (8 studies). [...]

    The search parameters identified 3,311 total studies, of which 3 studies (n=1,272 participants) met the inclusion criteria for this review. The participants in these studies included both pediatric and adult patients. The studies were all performed at single-center academic EDs in the United States and Canada. All studies excluded critically ill patients and one study excluded pediatric patients receiving supplemental oxygen at baseline. The definitions of the primary outcome of oxygen desaturation varied by study, including less than 93% for greater than 15 seconds (n=132),2 less than 90% for greater than 30 seconds (n=986),3 and less than 95% for any duration (n=154). [...]

    Approximately 300,000 patients are treated annually in US emergency departments (EDs) for cerebral transient ischemic attack.1 Their management is variable.1,2 Created in 1975, the historical definition3—focal neurologic symptoms with a vascular cause, lasting less than 24 hours—no longer makes sense in a world of magnetic resonance imaging (MRI), fibrinolytic treatment for ischemic stroke, and a better understanding of the ultraearly stroke risk after transient ischemic attack. The new definition of transient ischemic attack is “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction.”4 [...]

    We examine the association between emergency physician characteristics and practice factors with the risk of being named in a malpractice claim. [...]

    Futility often serves as a proposed reason for withholding or withdrawing medical treatment, even in the face of patient and family requests. Although there is substantial literature describing the meaning and use of futility, little of it is specific to emergency medicine. Furthermore, the literature does not provide a widely accepted definition of futility, and thus is difficult if not impossible to apply. Some argue that even a clear concept of futility would be inappropriate to use. This article will review the origins of and meanings suggested for futility, specific challenges such cases create in the emergency department (ED), and the relevant legal background. [...]

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    An update on push-dose pressors EMCrit by Scott Weingart. [...]

    In a previous post we discussed the use of IVC variation and the concept of fluid responsiveness. Despite a strong physiological basis, no studies examining the use of fluid responsiveness to guide resuscitative efforts in patients with septic shock have been shown to improve patient important outcomes. Shortly after this post was released, Critical Care […] EMCrit by Rory Spiegel. [...]

    Hemoptysis redux EMCrit by Scott Weingart. [...]

    We come from all the divisions, ranks, and classes of society…to teach and to be taught in our turn. While we mingle together in these pursuits we shall learn to know each other more intimately; we shall remove many of the prejudices which ignorance or partial acquaintance with each other had fostered…In the parties and […] EMCrit by Mike Lauria. [...]

    Nurses should be leading cardiac arrest management EMCrit by Scott Weingart. [...]

    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. [...]

    ercast.org Getting Sued This is not an easy episode. It’s not easy because a doctor gets named in a lawsuit, a patient has a bad outcome, and it openly discusses some of the systems failures we have in medicine. If that’s enough to turn you off, close the page and go about your day. You’ll probably be happier […] ercast.org - Emergency medicine podcasts, reviews and curbside consults [...]

    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 [...]

    If you are a senior resident, this post is for you! Right now you’re juggling an array of responsibilities. From adjusting to your new leadership roles in the Department to applying to jobs and fellowships, it’s easy to let that pesky procedure you have always struggled with or confusing ECG finding slip by you. To [...] The post Finish Strong: Top 10 Things to Master Before Graduating EM Residency appeared first on ALiEM. [...]

    Welcome to the beginning of the most exciting and terrifying time in your residency — the start to a new year! To help start the year off right a group of chief residents from across the country, through the ALiEM Chief Resident Incubator, have gotten together and compiled a list of ways for chief residents [...] The post Building a Cohesive Residency Program: Top 10 Strategies to Engage Residents appeared first on ALiEM. [...]

    Ok, while we congratulated the senior residents in our last piece, but let’s be honest, YOU (the junior faculty members) are the ones who TRULY should be congratulated. You’ve survived residency, and now you’re the boss! You’re probably sighing with relief at the moment. But eventually, you’ll ask yourself: “Now, what’s next?” Well, yet again, [...] The post ALiEM’s Greatest MEdIC Hits for New Academic Faculty: A Curated Collection of 8 Cases appeared first on ALiEM. [...]

    The PV Cards are getting a new name and their own website! Beginning today you can find the complete point-of-care reference library on its own standalone, mobile-enabled website: ALiEM Cards at www.aliemcards.com. The PV Cards have been in various formats whether they be apps and websites. Hopefully building a single repository, accessible on any device, will make the PV [...] The post Announcing the new ALiEM Cards website appeared first on ALiEM. [...]

    Wound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 [...] The post Trick of the Trade: DIY Squirt Bottle Wound Irrigation appeared first on ALiEM. [...]

    With consistent, adequate treatment, people with HIV have a life expectancy that is nearly normal. However, because HIV often affects the most vulnerable people in our society, getting that consistent treatment remains a real and important challenge. 30 years after And the Band Played On was first published, HIV/AIDS is now often viewed as a [...] The post ALiEM Book Club: And The Band Played On appeared first on ALiEM. [...]

    While we congratulated and welcomed the interns with the list of Greatest Hits for Interns, it’s high time we actually congratulate and welcome you… the new Senior Residents! You’ve toiled through call shifts on off-service rotations,  you’ve worked hard reviewing cases with junior residents and getting grilled you about the latest esoteric facts by the seniors! [...] The post ALiEM’s Greatest MEdIC Hits for New Senior Residents: A Curated Collection of 10 Cases appeared first on ALiEM. [...]

    The NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to [...] The post Trick of the Trade: Gaze Testing Using “Selfie Mode” on Your Smartphone Camera appeared first on ALiEM. [...]

    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. [...]

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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 [...]

    Take Home Point: In patients with diabetic gastroparesis, haloperidol may be an effective adjunctive treatment to prevent hospitalizations and reduce opi... Click to view the rest [...]

    Patients with psychiatric disorders are found globally, with a recent global burden of disease estimate that mental illness accounted for 32... Click to view the rest [...]

    --RV systolic function is negatively affected by high RV afterload --High mean airway pressures on the ventilator (particularly in modes ... Click to view the rest [...]

    The answer appears to be ... it depends. Early Oseltamivir Treatment in Influenza in Children1-3 Years of Age: A Randomized Controlled Tr... Click to view the rest [...]

    Patients with severe salicylate poisoning may require endotracheal intubation due to fatigue from hyperventilation or mental status change. A ... Click to view the rest [...]

    Improving Resuscitation Performance Resuscitating the critically ill patient can often be quite stressful. Stress has been shown... Click to view the rest [...]

    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 [...]

    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 → [...]