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Flomax for Ureteral Stones?

Using Flomax for ureteral stones has been a controversial topic. A meta-analysis of 8 randomized controlled trials consisted of 1,384 patients showed that there was no benefit in giving Flomax to those with ureteral stones < 5mm. However, Flomax was beneficial for patients with stones > 5mm (risk difference=22%; 95% confidence interval 12% to 33%;Read more

Intranasal Fentanyl

Delivering adequate analgesia in pediatric patients in a timely fashion is difficult. IV route requires staffing and produces additional pain and anxiety in this population. However, the oral route has a delayed onset. The benefit to IN fentanyl is that it can provide adequate control pain without IV access. Even if the patient still needsRead more

Etomidate vs. Ketamine

Both etomidate and ketamine are commonly used as the induction agent for RSI in adult trauma patients. There are concerns about etomidate-associated adrenal suppression leading to complications in critically ill patients. This is a retrospective study comparing the outcome of patients intubated in the ED with etomidate vs. ketamine. There were a total of 968Read more

Epistaxis

The current treatment for epistaxis consists of holding pressure, local vasoconstrictor, silver nitrate or anterior nasal packing. Recently, the use of topical TXA has been purposed. A previous study in 2013 showed that topical TXA resulted in shorter epistaxis control and shorter ED LOS in patients not on any anticoagulants or antiplatelets. A new randomizedRead more

The 52 in 52 Review: Absorbable Plain Gut vs. Nonabsorbable Nylon Suture in children

Article Citation: Karounis H, Gouin S, Eisman H, Chalut D, et al. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Acad Emerg Med. 2004 Jul;11(7):730-5. PMID: 15231459 What we already know about the topic: Traumatic lacerations are one of the most common causesRead more

Albumin in SBP?

We have many patients coming to our ED with cirrhotic liver disease with ascites. Up to 25% of patients with ascites have SBP. Once SBP has been identified, we use a third-generation cephalosporin to treat the patient. However, the benefit of albumin is questionable. Albumin can bind inflammatory cytokines and improve intravascular volume. Literature suggestsRead more

The 52 in 52 Review: Septic Joint vs. Transient Synovitis of the hip in children

Article Citation: Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004 Aug;86-A(8):1629-35. PMID: 15292409 What we already know about the topic: Differentiation between septic arthritis and transient synovitisRead more

52 in 52 Review: PE Rule Out with Wells and D-dimer

Title: “The 52 in 52 Review: PE Rule Out with Wells and D-dimer” Article Citation: Wells PS, Anderson DR, Rodger M, Stiell I, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. AnnalsRead more

Modified Valsava for SVT

Background: SVTs are commonly seen in the ED. Chemical cardioversion often takes several minutes to initiate because we have to get IV access and medication ready.  During this time, we can attempt some valsava maneuvers to cardiovert stable patients. Current valsava maneuvers have shown low efficacy 5-20%. The REVERT trial compared the standard Valsava toRead more

BiPAP

What’s the difference between BiPAP vs. CPAP? CPAP stands for continuous positive airway pressure. In other words, there is a continuous pressure regardless whether the patient is breathing in or out. CPAP only has one pressure setting. BiPAP has two pressure settings: inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). While theRead more