Blog

The 52 in 52 Review: PERC rule

Article Citation: Kline JA, et al. “Prospective multicenter evaluation of the pulmonary embolism rule-out criteria”. J Thromb Haemost. 2008. 6(5):772-780. What we already know about the topic: PERC (Pulmonary Embolism Rule-out Criteria): Age > = 50 years, Pulse >= 100, SpO2 <= 95% on RA, Unilateral leg swelling, Hemoptysis, Surgery or trauma < = 4 weeksRead more

Time is…..life: REALITY-AHF

Let’s wait for the chest x-ray they said….let’s try them on BiPAP first they said.   But were they correct? REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in the Emergency Department of Acute Heart Failure) was recently published in the Journal of the American College of Cardiology.  It is a prospective, multicenter, observation cohortRead more

Abscess in need, pus indeed

So you thought I&Ding your abscess was enough?  Or your attending told you….no cellulitis so no antibiotics?  WRONG! A recent double-blinded randomized-controlled trial of outpatient children and adults with abscesses <= 5cm who had I&D performed with either clindamycin or bactrim had higher cure rate at 7-10 days compared to the placebo group that hadRead more

“The 52 in 52 Review: Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock”

Title: “The 52 in 52 Review: Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock”     Article Citation: Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. Emanuel Rivers, M.D., M.P.H., Bryant Nguyen, M.D., Suzanne Havstad, M.A., Julie Ressler, B.S., Alexandria Muzzin, B.S., Bernhard Knoblich, M.D., Edward Peterson,Read more

Solar Retinopathy

So now that the biggest nature-themed event of 2017 is finished, we can all throw our rad NASA certified eclipse goggles into a drawer until 2024, when the next eclipse is due, and move on with our lives. Correct?   Wrong.   Nature is a cruel mistress, and if we think we can get awayRead more

All is FARES in Love and Shoulder Reductions

You’re in the middle of a busy Resus shift, no available beds, and someone asks you if they can bring back a patient for a procedural sedation to reduce a dislocated shoulder. “Arghhhhghgh” you think to yourself, “just what I need.” Tons of paperwork, consent forms, an extra nurse, getting the resident, attending, and patientRead more

The 52 in 52 Review: Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries

Article Citation: William H. Bickell, Matthew J. Wall, Jr., Paul E. Pepe, R. Russell Martin, Victoria F. Ginger, Mary K. Allen, and Kenneth L. Mattox. Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries. N Engl J Med 1994; 331:1105-1109. October 27, 1994. https://www.ncbi.nlm.nih.gov/pubmed/7935634   What we already know about the topic:Read more

The Use of Haloperidol in Diabetic Gastroparesis

  Few would argue that Gastroparesis (or, delayed gastric emptying) is in the pantheon of coolest topics in EM these days, and for good reason. Affecting diabetics, chronic marijuana users, long-term smokers, this disease causes the unpleasant combination of chronic nausea, frequent vomiting, and abdominal pain. It’s difficult to treat, often refractory to our mostRead more

Inhaled Isopropyl Alcohol for Rapid Treatment of Nausea

You are quietly typing away at your computer when the familiar (but not entirely pleasant) sound of retching fills the air. You look out onto the side and see a young woman dry-heaving into a pink plastic bucket, looking miserable. This person will obviously need anti-emetics, but you know that 30+ minutes may pass beforeRead more

Automatic Blood Pressure Cuffs: Sorcery or Engineering

Did you ever wonder how your automatic blood pressure cuff actually works? No? Just me? Well…no surprise there. When the machine inflates the cuff, its goal is to get it above the patient’s systolic blood pressure (table how it knows that for one second). It then uses this as its estimate for the next timeRead more