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Thanks to Bing, Dr. Okuda and Dr. Strother for a wonderful day of sim cases this week. Special thanks to all who had to tolerate my acting.

A few questions came up during the discussions, and, I’ve been trying to research with limited success.

The first question concerned antibiotics for heat illness. Certainly in ambiguous cases, where there is altered mental status with moderately high temperature, antibiotic coverage is mandated. But in our case, of the athlete on a hot day? It was asserted that the heat stress leads to gut flora dissemination, and antibiotics are warranted. But I could find no reference for this, and my usual sources are silent on the issue of prophylactic antibiotics.

The second question revolved around safety factors for emergent sedation. Specifically, I wondered if the risk of aspiration in emergent procedural sedation had been quantified in adults. It turns out there’s a lot of opinion on this matter, but not a lot of data. More below:

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Please join us this week for Emergency Medicine Departmental Conference, in the 8th floor conference room at Elmhurst Hospital.

The day’s activities are planned as follows:

8am Research Lecture Series — Non-Experimental Designs — Dr. Lynne Richardson
9am Journal Club — Dr. Shen (see below for articles)
10am Critical Care Lecture — Dr. Scott Weingart
11am Trauma Series — Dr. Fasina
12pm M&M — Dr. Bentley
1pm Senior Leadership Seminar with Dr. Stuart Kessler (optional)

Lunch will be served. Please note the early start time.

Residents: The following journal  club articles are accessible by entering the login and password from my email:

Primary discussion: Ohlmann P, et al. Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection. Crit Care Med. 2006 May;34(5):1358-64. PMID: 16557157.

Clinical background: Sodeck G et al. D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study. Eur Heart J. 2007 Dec;28(24):3067-75. PMID: 17986466.

Optional additional clinical background from JAMA’s Rational Clinical Exam Series: Klompas M. Does This Patient Have an Acute Thoracic Aortic Dissection? JAMA. 2002;287(17):2262-2272. PMID: 11980527.