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How much toradol?

Current FDA dosing for Toradol is 30mg IV and 60mg IM in patients < 65 years old.  But is that necessary? Let’s look at this randomized controlled trial: Motov S et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg MedRead more

The 52 in 52 Review

Article Citation: Holzer M, et al. “Mild Therapeutic Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest”. The New England Journal of Medicine. 2002. 346(8):549-556. What we already know about the topic: prelim studies demonstrated that lowering brain temp s/p cardiac arrest improves neurologic recovery. Why this study is important: Hypoxemic brain injury is the mostRead more

Steroids for everyone?

Of course your asthma patients with acute bronchitis will get some steroids….but what about your non-asthmatic patients?  Evidence shows that most patients with acute bronchitis do not need steroids. What’s the evidence? Study: double-blinded RCT of 401 patients with lower respiratory tract infection symptoms (wheezing) without history of asthma or COPD treated at different familyRead more

Can there possibly be a debate about cardiac standstill? And what is Kappa?

A study done by some of our favorite residents and attendings says there is a debate! They surveyed physician sonographers at 6 conferences in 3 academic medical centers in NY.  Each person was given 20 seconds per slide to determine whether each of the 15 video clips of patients in cardiac arrest were standstill orRead more

Dex or Pred?

Is one dose of PO dexamethasone enough or do you need to send your adult asthmatic patient home on a 5 day oral prednisone course? A noninferiority study published in Annals of Emergency Medicine in 2016 says maybe it doesn’t matter. What was the study? Adult ED patients ages 18-55 were randomized to receive eitherRead more

The 52 in 52 Review

Article Citation: Stiell IG, Wells GA, Vandemheen KL, Clement CM, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. What we already know about the topic: More than a million patients treated annually in EDs around the country for blunt trauma and possible c-spine injury andRead more

Beta blocker or Calcium Channel Blocker?

We have all encountered patients with Afib with RVR who require rate control and the question always is…..what drug? Some people prefer CCB like diltiazem while others prefer beta blockers like labetalol.  Is one better than the other? A recent study published in Academic Emergency Medicine looks at Afib patients who visited one of 24Read more

Here is a familiar scenario…..You need an emergent CT with IV contrast- whether it’s a trauma patient or a stroke patient or PE or dissection and you just don’t have the time to wait for a creatinine. Are you going to harm the patient by giving IV contrast? Want to sound informed when talking toRead more

Hot sauce!

Remember your chronic cannabinoid user that comes in with hyperemesis.   They have Cannabinoid hyperemesis syndrome (CHS): cyclic abdominal pain, nausea, and vomiting in the setting of chronic cannabis use. You try every anti-emetic  in your ED but still vomiting.  These patients usually get relief from hot showers but of course your patient already knows thatRead more

The 52 in 52 review: ABCD2 score

Article Citation: Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283-92. What we already know about the topic: A patient with a TIA is at increased risk of stroke but it’s hard to predict how likely an individualRead more