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ER Dogma

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By David Rhine MD FRCPC. Emergency medicine. Special interest in concussion management.
Oliva Ortiz-Alvarez
Croup is one of the most common causes of upper airway obstruction in young children. It is characterized by sudden onset of barky cough, hoarse voice, inspiratory stridor and respiratory distress caused by upper airway inflammation secondary to a viral infection. Published guidelines for the diagnosis and treatment of croup advise using steroids as the mainstay treatment for all children who present to emergency department (ED) with croup symptoms. Dexamethasone, given orally as a single dose at 0.6 mg/kg, is highly efficacious in treating croup symptoms...
June 2017: Paediatrics & Child Health
Diana K Coleman, Brit Long, Alex Koyfman
BACKGROUND: Syncope is an event that causes a transient loss of consciousness (LOC) secondary to global cerebral hypoperfusion. The transient nature of the event can make diagnosis in the emergency department (ED) difficult, as symptoms have often resolved by time of initial presentation. The symptoms and presentation of syncope are similar to many other conditions, which can lead to difficulty in establishing a diagnosis in the ED. OBJECTIVE: This review evaluates patients presenting with a history concerning for possible syncope, mimics of syncope, and approach to managing syncope mimics...
January 2018: Journal of Emergency Medicine
Tina Hu, William Watson
No abstract text is available yet for this article.
March 2018: Canadian Family Physician Médecin de Famille Canadien
Michael Gottlieb, Joshua M DeMott, Marilyn Hallock, Gary D Peksa
STUDY OBJECTIVE: The addition of antibiotics to standard incision and drainage is controversial, with earlier studies demonstrating no significant benefit. However, 2 large, multicenter trials have recently been published that have challenged the previous literature. The goal of this review was to determine whether systemic antibiotics for abscesses after incision and drainage improve cure rates. METHODS: PubMed, the Cumulative Index of Nursing and Allied Health Literature, Scopus, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all randomized controlled trials comparing adjuvant antibiotics with placebo in the treatment of drained abscesses, with an outcome of treatment failure assessed within 21 days...
March 9, 2018: Annals of Emergency Medicine
Peter K Moore, Raymond K Hsu, Kathleen D Liu
Acute kidney injury (AKI) is a heterogeneous disorder that is common in hospitalized patients and associated with short- and long-term morbidity and mortality. When AKI is present, prompt workup of the underlying cause should be pursued, with specific attention to reversible causes. Measures to prevent AKI include optimization of volume status and avoidance of nephrotoxic medications. Crystalloids are preferred over colloids for most patients, and hydroxyethyl starches should be avoided. Volume overload in the setting of AKI is associated with adverse outcomes, so attention should be paid to overall fluid balance...
February 22, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jonathan Stone, Patrick Hangge, Hassan Albadawi, Alex Wallace, Fadi Shamoun, M Grace Knuttien, Sailendra Naidu, Rahmi Oklu
Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000-100,000 deaths annually. Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors. Virchow's Triad distills the multitude of risk factors for DVT into three basic elements favoring thrombus formation: venous stasis, vascular injury, and hypercoagulability...
December 2017: Cardiovascular Diagnosis and Therapy
Prashanth Rawla, Anantha R Vellipuram, Sathyajit S Bandaru, Jeffrey Pradeep Raj
Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus, a high clinical suspicion is warranted, and other diagnosis ruled out. Here, we present two patients on regular insulin treatment who were admitted with a diagnosis of EDKA. The first patient had insulin pump failure and the second patient had urinary tract infection and nausea, thereby resulting in starvation...
2017: Endocrinology, Diabetes & Metabolism Case Reports
Mary Beth F Son, Jane W Newburger
No abstract text is available yet for this article.
February 2018: Pediatrics in Review
Franz E Babl, Ed Oakley, Stuart R Dalziel, Meredith L Borland, Natalie Phillips, Amit Kochar, Sarah Dalton, John A Cheek, Yuri Gilhotra, Jeremy Furyk, Jocelyn Neutze, Susan Donath, Stephen Hearps, Charlotte Molesworth, Louise Crowe, Silvia Bressan, Mark D Lyttle
STUDY OBJECTIVE: Three clinical decision rules for head injuries in children (Pediatric Emergency Care Applied Research Network [PECARN], Canadian Assessment of Tomography for Childhood Head Injury [CATCH], and Children's Head Injury Algorithm for the Prediction of Important Clinical Events [CHALICE]) have been shown to have high performance accuracy. The utility of any of these in a particular setting depends on preexisting clinician accuracy. We therefore assess the accuracy of clinician practice in detecting clinically important traumatic brain injury...
February 13, 2018: Annals of Emergency Medicine
Rachel Bystritsky, Henry Chambers
Cellulitis and soft tissue infections are a diverse group of diseases that range from uncomplicated cellulitis to necrotizing fasciitis. Management of predisposing conditions is the primary means of prevention. Cellulitis is a clinical diagnosis and thus is made on the basis of history and physical examination. Imaging may be helpful for characterizing purulent soft tissue infections and associated osteomyelitis. Treatment varies according to the type of infection. The foundations of treatment are drainage of purulence and antibiotics, the latter targeted at the infection's most likely cause...
February 6, 2018: Annals of Internal Medicine
Brit Long, Jennifer Robertson, Alex Koyfman, Kurian Maliel, Justin R Warix
BACKGROUND: Atrial fibrillation (AF) is an abnormal heart rhythm which may lead to stroke, heart failure, and death. Emergency physicians play a role in diagnosing AF, managing symptoms, and lessening complications from this dysrhythmia. OBJECTIVE: This review evaluates recent literature and addresses ED considerations in the management of AF. DISCUSSION: Emergency physicians should first assess patient clinical stability and evaluate and treat reversible causes...
January 30, 2018: American Journal of Emergency Medicine
Sheba Jarvis, Pooja Dassan, Catherine Nelson Piercy
No abstract text is available yet for this article.
January 25, 2018: BMJ: British Medical Journal
Edward Carlton, Richard Body
Chest pain of suspected cardiac origin is a very common emergency department presentation. Over the past decade, there has been an exponential growth in strategies that promote blood sampling at earlier and earlier time points after presentation to facilitate the rule out of acute coronary syndrome.In part 2 of this series, we examine key concepts from the recent literature with the aim of improving clinicians' understanding of the rule-out strategies available to them and provide a structured overview of strategies that facilitate discharge with blood testing over <3 hours...
March 2018: Emergency Medicine Journal: EMJ
Robert M Carey, Paul K Whelton
Description: In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. This article summarizes the major recommendations. Methods: In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure...
January 23, 2018: Annals of Internal Medicine
Cortlyn Brown, Karim Elmobdy, Ali S Raja, Robert M Rodriguez
BACKGROUND: Scapular fractures have been traditionally taught to be associated with significant injuries and major morbidity. As we demonstrated with sternal fracture, pulmonary contusion and rib fracture, increased chest CT utilization and head-to-pelvis CT (pan-scan) protocols in blunt trauma evaluation, however, may diagnose minor, clinically irrelevant scapular fractures, possibly rendering previous teachings obsolete. OBJECTIVES: To determine the 1) percentages of scapular fractures seen on chest CT only (SOCTO) versus seen on both CXR and CT and of isolated scapular fracture (scapular fracture without other thoracic injuries), 2) frequencies of associated thoracic injury with scapular fracture, and 3) proportion of patients admitted, mortality, hospital length of stay, and injury severity scores (ISS), comparing four patient groups: scapular fracture, non-scapular fracture, scapular fracture SOCTO, and isolated scapular fracture...
January 11, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Alexander W Chessman
No abstract text is available yet for this article.
January 16, 2018: Annals of Internal Medicine
Michael Gottlieb, Brit Long, Alex Koyfman
BACKGROUND: Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage. OBJECTIVE: With the new evidence concerning the evaluation and treatment of urolithiasis, this review summarizes current literature regarding the ED management of urolithiasis. DISCUSSION: Urolithiasis occurs primarily through supersaturation of urine and commonly presents with flank pain, hematuria, and nausea/vomiting...
January 5, 2018: American Journal of Emergency Medicine
Daniel K Nishijima, Amber L Lin, Robert E Weiss, Annick N Yagapen, Susan E Malveau, David H Adler, Aveh Bastani, Christopher W Baugh, Jeffrey M Caterino, Carol L Clark, Deborah B Diercks, Judd E Hollander, Bret A Nicks, Manish N Shah, Kirk A Stiffler, Alan B Storrow, Scott T Wilber, Benjamin C Sun
STUDY OBJECTIVE: Cardiac arrhythmia is a life-threatening condition in older adults who present to the emergency department (ED) with syncope. Previous work suggests the initial ED ECG can predict arrhythmia risk; however, specific ECG predictors have been variably specified. Our objective is to identify specific ECG abnormalities predictive of 30-day serious cardiac arrhythmias in older adults presenting to the ED with syncope. METHODS: We conducted a prospective, observational study at 11 EDs in adults aged 60 years or older who presented with syncope or near syncope...
December 21, 2017: Annals of Emergency Medicine
Eric Balighian, Michael Burke
No abstract text is available yet for this article.
January 2018: Pediatrics in Review
Andrea L Austin
No abstract text is available yet for this article.
August 2017: Annals of Emergency Medicine
2017-12-24 16:36:09
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