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ER Dogma

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By David Rhine MD FRCPC. Emergency medicine. Special interest in concussion management.
Chris Maher, Martin Underwood, Rachelle Buchbinder
Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review...
October 10, 2016: Lancet
Catherine McParlin, Amy O'Donnell, Stephen C Robson, Fiona Beyer, Eoin Moloney, Andrew Bryant, Jennifer Bradley, Colin R Muirhead, Catherine Nelson-Piercy, Dorothy Newbury-Birch, Justine Norman, Caroline Shaw, Emma Simpson, Brian Swallow, Laura Yates, Luke Vale
Importance: Nausea and vomiting affects approximately 85% of pregnant women. The most severe form, hyperemesis gravidarum, affects up to 3% of women and can have significant adverse physical and psychological sequelae. Objective: To summarize current evidence on effective treatments for nausea and vomiting in pregnancy and hyperemesis gravidarum. Evidence Review: Databases were searched to June 8, 2016. Relevant websites and bibliographies were also searched...
October 4, 2016: JAMA: the Journal of the American Medical Association
Perenlei Enkhbaatar, Basil A Pruitt, Oscar Suman, Ronald Mlcak, Steven E Wolf, Hiroyuki Sakurai, David N Herndon
Smoke inhalation injury is a serious medical problem that increases morbidity and mortality after severe burns. However, relatively little attention has been paid to this devastating condition, and the bulk of research is limited to preclinical basic science studies. Moreover, no worldwide consensus criteria exist for its diagnosis, severity grading, and prognosis. Therapeutic approaches are highly variable depending on the country and burn centre or hospital. In this Series paper, we discuss understanding of the pathophysiology of smoke inhalation injury, the best evidence-based treatments, and challenges and future directions in diagnostics and management...
October 1, 2016: Lancet
Matthew Pritam Taylor, Paul Wrenn, Andrew David O'Donnell
BACKGROUND: Injury to the spinal cord can result in loss of sympathetic innervation causing a drop in BP and HR, this condition is known as neurogenic shock. There is debate among the literature on how and when neurogenic shock presents and what values of HR and BP should be used to define it. Previous studies do not take into account multiple prehospital and emergency department recordings. OBJECTIVE: To improve understanding of how neurogenic shock presents in humans, allowing better identification and treatment...
October 3, 2016: Emergency Medicine Journal: EMJ
Robert M McCarron, Erik R Vanderlip, Jeffrey Rado
This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers...
October 4, 2016: Annals of Internal Medicine
Brit Long, Alex Koyfman
INTRODUCTION: Organ transplantation provides improved quality of life and longevity in patients with end-organ disease. These patients have significant physiological and anatomical modifications, and with new immunosuppressive agents, many of these patients will present to the emergency department with complications. OBJECTIVE: The objective was to provide emergency physicians with a review of transplant complications, including infection, rejection, medication adverse effects, and specific complications related to the transplant...
August 27, 2016: American Journal of Emergency Medicine
M Celeste Simon
No abstract text is available yet for this article.
September 13, 2016: New England Journal of Medicine
Graeme J Hankey
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterectomy for symptomatic carotid stenosis...
September 13, 2016: Lancet
Ralph C Wang, Rebecca Smith-Bindman, Evans Whitaker, Jersey Neilson, Isabel Elaine Allen, Marshall L Stoller, Jahan Fahimi
STUDY OBJECTIVE: Tamsulosin is recommended for patients receiving a diagnosis of a ureteral stone less than 10 mm who do not require immediate urologic intervention. Because of conflicting results from recent meta-analyses and large randomized controlled trials, the efficacy of tamsulosin is unclear. We perform a systematic review and meta-analysis to investigate the effect of tamsulosin on stone passage in patients receiving a diagnosis of ureteral stone. METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched without language restriction through November 2015 for studies assessing the efficacy of tamsulosin and using a double-blind, randomized, controlled trial design...
September 7, 2016: Annals of Emergency Medicine
Juan González Del Castillo, Francisco Javier Ayuso, Victoria Trenchs, Mikel Martinez Ortiz de Zarate, Carmen Navarro, Kinda Altali, Cristina Fernandez, David Huckins, Francisco Javier Martín-Sánchez
OBJECTIVE: Evaluate the diagnostic accuracy of the APPY1 Test alone and in combination with the Alvarado score (AS) to rule out acute appendicitis (AA) in patients presenting to EDs with abdominal pain suspicious for AA. METHODOLOGY: Observational study in a prospective consecutive cohort including all patients from 2 to 20 years with abdominal pain suggestive of AA in four EDs. The APPY1 Test was performed and AS was calculated to determine risk stratification for each patient...
September 9, 2016: Emergency Medicine Journal: EMJ
Jagannadha Avasarala
No abstract text is available yet for this article.
September 6, 2016: JAMA Neurology
Benson S Hsu, Saquib A Lakhani, Michael Wilhelm
No abstract text is available yet for this article.
September 2016: Pediatrics in Review
Saman Shabani, Ha Son Nguyen, Ninh Doan, Jamie L Baisden
BACKGROUND: The authors present a case of delayed acute subdural hematoma and review all reported cases in the literature. CASE DESCRIPTION: 75-year-old female on daily 81mg ASA who had a fall with LOC. Her GCS was 15 at the time of presentation to the ED. However, due to her post-concussive symptoms, CToH was obtained which was negative for any intracranial hemorrhage or fractures. She was admitted for work-up. The next day, she neurologically deteriorated to GCS of 6...
August 24, 2016: World Neurosurgery
I Vanessa Marin Collazo, William O Tatum
Sudden unexpected death in epilepsy (SUDEP) is a devastating direct epilepsy-related cause of death. Although its occurrence has some risk factors, it is unanticipated and very traumatic to the families of affected patients. Effective preventive measures for SUDEP are lacking; therefore, efforts are directed at modifiable risk factors. The majority of caregivers of patients with epilepsy and SUDEP wish they would have known more about the topic before the terminal event. SUDEP is a difficult topic for physicians and clearly even more challenging to discuss with patients and caregivers...
July 2016: Neurologist
Graeme J Hankey
No abstract text is available yet for this article.
August 16, 2016: Annals of Internal Medicine
Nizhoni Denipah, Christopher M Dominguez, Erik P Kraai, Tania L Kraai, Paul Leos, Darren Braude
Paradoxical vocal fold motion disorder, also commonly termed vocal cord dysfunction, is a poorly understood cause of acute upper airway obstruction. Patients with paradoxical vocal fold motion frequently present to the emergency department (ED) with acute respiratory distress and stridor. Lack of familiarity with this disorder may lead to delayed diagnosis or misdiagnosis and unnecessary intubations or surgical airway procedures. Although long-term management of paradoxical vocal fold motion is well described, there is a paucity of information about acute evaluation and management...
August 10, 2016: Annals of Emergency Medicine
Aarti Dalal, Richard J Czosek, Joshua Kovach, Johannes C von Alvensleben, Santiago Valdes, Susan P Etheridge, Michael J Ackerman, Debbie Auld, Jeryl Huckaby, Courtney McCracken, Robert Campbell
OBJECTIVES: To identify the clinical presentation of children and adolescents affected by 1 of 4 cardiac conditions predisposing to sudden cardiac arrest: hypertrophic cardiomyopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and anomalous origin of the left coronary artery from the right sinus of Valsalva (ALCA-R). STUDY DESIGN: This was a retrospective review of newly diagnosed pediatric patients with hypertrophic cardiomyopathy, LQTS, CPVT, and ALCA-R referred for cardiac evaluation at 6 US centers from 2008 to 2014...
October 2016: Journal of Pediatrics
Arianne P Verhagen, Aron Downie, Nahid Popal, Chris Maher, Bart W Koes
OBJECTIVE: The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. METHOD: We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology...
September 2016: European Spine Journal
Marian E Betz, Matthew Wintersteen, Edwin D Boudreaux, Gregory Brown, Lisa Capoccia, Glenn Currier, Julie Goldstein, Cheryl King, Anne Manton, Barbara Stanley, Christine Moutier, Jill Harkavy-Friedman
Emergency departments (ED) are prime locations for identifying individuals at high risk of suicide and for making life-saving interventions. In an ideal scenario, all ED patients at risk of suicide could be identified and connected with effective, feasible interventions, and this would occur in a supportive system not overburdened by screening or assessment requirements. In this review, we focus on challenges to achieving this ideal--along with potential solutions--at the level of patients, providers, the ED environment, and the larger health care system...
July 20, 2016: Annals of Emergency Medicine
Latha Ganti, Yasamin Daneshvar, Sarah Ayala, Aakash N Bodhit, Keith R Peters
BACKGROUND: Traditionally, neurocognitive testing is performed weeks to months after head injury and is mostly performed on patients who continue to have symptoms or difficulties. In this study, we sought to determine whether these tests, when administered acutely, could assist in predicting short-term outcomes after acute traumatic brain injury (TBI). METHODS: This is an IRB-approved prospective study of adult patients who came to the emergency department of our Level-1 trauma center with TBI...
2016: Military Medical Research
2016-07-27 13:59:39
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