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…
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….
PEARL: Antipyretics (NSAIDS or acetaminophen) are not associated with improved 28-day ICU mortality in septic patients. CONTEXT: Septic patients often have fevers. Someone always wants to lower the fever with acetaminophen. For conscious, n…
Aspirin and Head Trauma: More Dangerous Than You Think B.L.U.F: In one retrospective study of patients who fell from standing, aspirin was associated with double the rate of traumatic ICH compared to warfarin use. CONTEXT: We know to treat…
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…
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…
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:…
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 whethe…
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….
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…
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…
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…
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…
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…
Desaturation leading to hypoxemia during RSI is a familiar picture and apneic oxygenation was developed to prevent occurrence of oxygen desaturation during apneic period. Does the latest evidence support this practice? ENDAO trial publishe…
