What the Dipstick Tells You

Pearl(s): If the nitrite and LE results are concordant (both + or both – ), the test is accurate ~90% of the time. Leuk esterase has a lower PPV (higher FP rate) than nitrites, especially in low prevalence populations and in the ER In…

The 52 in 52 Review: BNP for CHF

Article Citation: McCullough PA, Nowak RM, McCord J, Hollander JE, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation….

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 regim…

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 st…

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:…

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….

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 mill…

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…

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 you…

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…

September 2017