Prompted by our M&M yesterday, below are the data surrounding delayed vs early cholecystectomy in patients with acute calculous cholecystitis. TL;DR: Current evidence supports early cholecystectomy provided the patient is medical…
Case: Unk-FrequentFlyer is rushed back to you in the cardiac room by Unk-Intern. He was found in the back corner of the B side shortly after 7am sign out. The patient is in florid alcohol withdrawal, combative, hallucinating, and of course…
In asthmatics requiring endotracheal intubation airway stimulation can induce severe reflex-mediated bronchoconstriction. This reflex is neurally mediated in part by the vagal nerves. Is there any evidence for the use of lidocaine pretreatm…
Is bandemia with a normal WBC count concerning? TL;DR: Bandemia is concerning even in the absence of leukocytosis and/or abnormal temperature Drees et al evaluated whether patients admitted to the hospital with a normal WBC an…
Google recently published a study online (not peer reviewed) of its AI system that predicts medical outcomes such as in patient mortality, readmission, etc There is a lot of technical jargon in the paper, but here is a brief summary: -Previ…
This post is meant to be an update to yesterday’s post on the CDC recommendations regarding Tamiflu. Most of this information will be based off of a 2014 Cochrane Review. Toward the end of this post I will delve into the controversia…
There is a lot of controversy surrounding the use and efficacy of Tamiflu. Below is a brief review of Tamiflu per the CDC. TL;DR -Likely some benefit in elderly (>65y/o), young (<2 y/o), chronically ill, or hospitalized patient…
We don’t often put in subclavian TLCs in the ED because of the increased risk of complications, specifically pneumothorax. Often, it’s difficult to do with US guidance so we turn to placing IJ TLCs instead. However, there are ce…
Case You receive RESUS signout on a 60F DMII, HTN here with urosepsis s/p abx, lactate downtrending, BPs holding in the 90s-low 100s systolic with IVF. Only thing left to do is talk to the MICU. You note the patient to be in persistent afib…
Should patient with severe sepsis receive steroids? Multiple trials have evaluated this question with varying results The ADRENAL Trial sheds some light on this question. The answer: Probably not TLDR: Does hydrocortisone reduce mort…
Today’s TR Pearl was inspired by an actual in-flight emergency i helped out with last year. The Case You’re on a flight home from vacation, finally fell asleep only to be woken up by your girlfriend: “Wake up, that passeng…
Noninvasive cardiac testing comes in multiple forms. There is the dobutamine or exercise stress echocardiography (DSE/ExSE), myocardial perfusion scintigraphy (MPS)–single photon emission computed tomography (SPECT), and cardiac magnetic re…
You’re in your Intake/Fast Track shift and you see a 94 year old patient who had a trip and fall earlier today and now has elbow pain. The elbow is tender and xray shows a fracture dislocation. You call your local ortho and they want…
So you’re working your pediatric shift again and you see a child who fell and hit his chin on a table and now has a tongue laceration which you’ve deemed needs repair (see prior post for criteria). How are you going to anestheti…
You’re in a small community ED and the only overnight doctor and you’ve found yourself with a difficult airway. Direct laryngoscopy has failed, video didn’t get a great view, bougie was surprisingly unhelpful, your LMA isn…
