Source: See citation below Pearl: When applying the Ottawa Ankle Rule, we specifically palpate the posterior maleoli. Explanation: When reviewing the Ottawa Ankle Rule today during morning report the question came up: why do we specificall…
Note: Some of the junior residents are unaware of what the 52 in 52 Review is. In brief. The ALIEM blog picked a list of 52 influential papers in EM (we are on version 2 now) to provide a weekly reading topic. The full list is available her…
By Jer5150 – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19669589 Pearl: In cardiac arrest, consider esmolol (500mcg/kg loading dose, then 0-100mcg/kg/min drip) for refractory ventricular fibrillation. Back…
My Hospital computer would not permit an image pertinent to this post to be downloaded without admin privileges, so here is a photo of Quinoa. Pearl: Lidoderm 4% patches are available over the counter. Lidoderm 5% patches are prescription o…
(1) Pearl: If forced to ration, the evidence may support targeting tetanus boosters among our ED wounded to patients in the following categories: A) Any wound and over 50 or never immunized B) Grossly soiled/crushed wound and >5 years si…
Note: Last week’s article, as selected by 52 in 52, was the NEXUS study methodology. I erroneously assumed that the other NEXUS article would be the results, but it was not. I don’t want to leave everyone with a cliffhanger, so…
Risus Sardonicus. (1) Welcome to Tetanus Week! Tetanus is something we deal with every day but to which we give little educational thought. That changes this week. Up first: Are you giving the right medication? Pearl: Patients who were inco…
By James Heilman, MD – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=56596333 Pearl: TXA can be used for post-partum hemorrhage. Its utility for other forms of gynecologic bleeding is unclear. Background: TXA…
Intraluminal Catheter Encrustation. Photo Credit: Royal Society of Chemistry. http://pubs.rsc.org/-/content/articlehtml/2017/tb/c7tb01302g. Pearl: There is likely little advantage gained from treating asymptomatic bacteriuria in patients wi…
Brief Note: This article is a methods-only paper. The results of the Nexus study will be discussed in next week’s 52-in-52 Pearl. Article Citation: Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blun…
Pearl: When reading the antibiotic sensitivity chart for your patient’s current (or former) infection, you cannot use the MIC numerical values to compare antibiotics. Just stick to sensitive/resistant. Question: When you look up the a…
Pearl: For patients with a true penicillin allergy, especially a Type I (IgE) reaction, increased cross-reactivity with first generation cephalosporins is real, but with third generation is not. Background: Some of us were taught a cross-re…
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…
