52 in 52: Ottawa Subarachnoid Hemorrhage Rule

Citation Perry JJ, Stiell IG, Sivilotti ML, et al. High-risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 2010;341:c5204 Resident Reviewer Carl Mickman Why this study is important Subarachnoid hemorrhage (SAH) is one of the most dangerous diagnoses made in the emergency department, and a large amount of resourcesRead more

Coach, I Jammed My Finger, Can I Still Play?

    Jammed fingers are a very common complaint in the emergency department, and while often sent home as soon as we verify they don’t have a fracture, there is another more serious complication that needs to be on our radar. Mallet finger, or baseball finger, is often caused by a sudden force that causesRead more

Trigger Point Injections

Back pain-related complaints account for millions of visits in emergency departments every year, and all of us have had patients that despite our best efforts aren’t satisfied with their pain control. Trigger point injections of local anesthetics well as anti-inflammatory medications have been common treatments in chronic pain and headache clinics for years, and areRead more

Tenebrous Tenets of Testicular Torsion

Testicular torsion is one of the most concerning diagnoses we can see in the emergency department, but a lot of the things we have come to accept as dogma regarding this dangerous diagnosis aren’t always as straightforward as board exams would have you believe! Dogma #1: Thunderclap Onset: Onset can be insidious, and may presentRead more

52 in 52 Review: POCUS vs CT for Suspected Nephrolithiasis

Citation Smith-Bindman, C. Aubin, J. Bailitz, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med, 371 (2014), pp. 1100–1110. Resident Reviewer Carl Mickman Why this study is important The use of non-contrast CT has been the gold standard for diagnosing renal colic despite suggestion that ultrasound could also be used asRead more

Other Options for Opiate Withdrawal Treatment

All of us have seen the acutely withdrawing opiate abuser during our times in the emergency department, however aside from a little bit of clonidine and enrollment in a methadone clinic, it can sometimes seem like our options are fairly limited in treating these patients. It is rare as ED docs that we are ableRead more

How low should you go?

  Hyperglycemia is frequently seen in the ED.  Practice variation is common in terms of glucose reduction for safe discharge.  The question is does improving this number benefit our patients?? Study: Driver, B et al. Discharge Glucose is Not Associated With Short-Term Adverse Outcomes in Emergency Department Patients With Moderate to Severe Hyperglycemia. Annals ofRead more

Pre-charging the Defibrillator in ACLS

During ACLS, valuable seconds are often wasted while trying to analyze the rhythm on the tiny monitor. Is it VT? VF? PEA? Then when we decide we do want to deliver the shock, even more time is wasted charging the defibrillator. All this lost time translates to decreased time delivering perfusion-delivering compressions in critically illRead more

52 in 52 Review: HINTS to diagnose stroke in the acute vestibular syndrome

  Citation Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. 2009. HINTS to diagnose stroke in the acute vestibular syndrome. Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40:3504–10 Resident Reviewer Carl Mickman Why this study is important Posterior circulation strokes are extremely difficult to diagnose in the emergencyRead more

Phlebotomy for Acute Crashing Pulmonary Edema in Dialysis Patients

Blood-letting was once one of the main medical treatments offered to patients before the advent of modern medicine, but did you know it is still a possible therapy that can be used in the ED today? According to a study by Eiser et al in 1997, and advocated by Dr. Reuben Strayer on the EM:RAPRead more