Dose Finding and Titration for Patients on Chronic Prescribed Opioids

Posted on by Nicholas Nasser, MD, MPH

As Emergency Physicians, the treatment of acute pain is our forte! However, it can become more challenging when patients with chronic pain—often on baseline prescribed opioids—present with severe or breakthrough pain. Likewise, converting between opioids or changing to IV formulations can be confusing and intimidating.  One of the easiest ways to get started is by calculating […]

Responding to Emotion with Respect in the Emergency Department

Posted on by Nicholas Nasser, MD, MPH

I wanted to share a quick communication teaching pearl pulled from Vital Talk, a platform created by palliative medicine physicians to help all clinicians improve how we talk with patients and families—especially in moments of high emotion. Their guide offers a simple, effective framework we can bring into the ED every shift by incorporating NURSE Statements: Some things to […]

Ocular POCUS and ICP Elevation
Posted on by Daniel Thomas

The Case: A woman in her twenties with no significant medical history presents with one month of progressive frontal headaches radiating to her occiput. Her headaches have been intermittent, however over the past few days she has had a few episodes of vomiting and brief episodes of blurred vision. Her headache is 8/10 currently. Last […]

Utilization of Sepsis Order Sets Lowers Hospital Mortality
Posted on by Matt Ashton

Have you ever wondered why you get so many epic chats reminding you to use the sepsis order set? Or why you are constantly reminded to reassess the status of your patient to see if they still meet sepsis requirements?  Well, there is a good reason, there is strong evidence to back up the use […]

Review of: Capacity, Informed Consent & Third-Party Decision Making
Posted on by Matt Ashton

My TR pearl this week is ethics-related and was inspired by the piece that Charles Sanky sent out last week, “Capacity, Informed Consent and Third-Party Decision-Making” written by Jacob Appel, a Mount Sinai Emergency Psychiatrist and Bioethicist.  I agree with Charles that this is an excellent introduction and encourage everyone to read this piece when you have the […]

ED Documentation
Posted on by Matt Ashton

I know that documenting feels like the bane of our existence most of the time, but it is one of the most important things that we do, for a variety of reasons. The following pearl is going to go through aspects of documentation that I believe are important for residents to know.  Side note, I by no […]

Ultrasound in Cardiac Arrest
Posted on by Shivam Shah MD MS

Ultrasound during cardiac arrest has quickly become standard. Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. To decrease time between compressions, many protocols were proposed (see here). One such protocol that successfully decreased time between compressions is the CASA (Cardiac Arrest Sonographic Assessment) protocol.  The CASA protocol assesses for cardiac tamponade, right heart strain, […]

Managing Acute Kidney Injury in the ED
Posted on by Shivam Shah MD MS

Today we’ll be discussing acute kidney injury (AKI). How often are you looking at the Bun/Cr thinking ‘Patient has an AKI’…and then not much more? I’ve done this. While ascertaining the underlying etiology is not always necessary in the ED, understanding AKI management, principles, and follow-up are important given the increased risk for progression to CKD and increased mortality  (This […]

Can you Discharge a Pulmonary Embolism
Posted on by Shivam Shah MD MS

There are almost 1,000,000 pulmonary embolisms per year. Do all of them need to be admitted? From a dispo standpoint, it can be easier when you’re at larger academic centers to admit or obs them all but the reality is that some of them can be discharged!  First off, this is attending-dependent. The idea of discharging PE’s […]

Subcutaneous Insulin in DKA
Posted on by Jackson Runte

Insulins and DKA came up in conference last week, but we didn’t discuss the use of subcutaneous insulin in DKA. SQ insulin is a potential alternative to IV therapy in mild to moderate DKA, and I think there is still a lot of variability in provider familiarity and comfort with this treatment approach. Why use […]

Asylum
Posted on by Neha S

Review of definitions – Migrant – a person who moves from one place to another – Refugee – a person fleeing persecution or fear of persecution on one of 5 protected grounds.  – Asylum seeker – a refugee seeking protection from within the United States – 5 protected grounds: race, nationality, religion, political opinion, social group not protected: climate disasters, civil wars, poverty […]

A Broad Overview of Health Systems around the World
Posted on by Neha Sikka

1. New Zealand – The “Beveridge” Model Other countries: UK, Cuba, Spain How it works: Healthcare is provided and financed by the government. The government owns hospitals and clinics and doctors may either be hired by the government or privately but are paid by the government.  Benefits: Universal coverage, lower cost of healthcare, fewer disparities Drawbacks: Long wait times, limited available […]