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 your ED but still vomiting.  These patients usually get relief from hot showers but of course your patient already knows that […]

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 the topic: A patient with a TIA is at increased risk of stroke but it’s hard to predict how likely an individual […]

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 published in Acad Emerg Med is an RCT (first one!) conducted at an academic ED in NYC.   100 patients were randomized to no […]

Concerned about a SAH?  The thunderclap worst headache of your patient’s life?  Recent data suggests that a negative head CT within 6 hours of symptom onset in a neurologically intact patient doesn’t warrant an LP. Perry et al: Multicenter prospective cohort study 240/3132 (7.7%) had SAH overall SAH defined as: visualized on noncontrast head CT, […]

Article Citation: Kline JA, et al. “Prospective multicenter evaluation of the pulmonary embolism rule-out criteria”. J Thromb Haemost. 2008. 6(5):772-780. What we already know about the topic: PERC (Pulmonary Embolism Rule-out Criteria): Age > = 50 years, Pulse >= 100, SpO2 <= 95% on RA, Unilateral leg swelling, Hemoptysis, Surgery or trauma < = 4 weeks […]