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ER Dogma

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By David Rhine MD FRCPC. Emergency medicine. Special interest in concussion management.
Brit Long, Alex Koyfman
INTRODUCTION: Infectious endocarditis (IE) is a potentially deadly disease without therapy and can cause a wide number of findings and symptoms, often resembling a flu-like illness, which makes diagnosis difficult. OBJECTIVE: This narrative review evaluates the presentation, evaluation, and management of infective endocarditis in the emergency department, based on the most current literature. DISCUSSION: IE is due to infection of the endocardial surface, most commonly cardiac valves...
July 2, 2018: American Journal of Emergency Medicine
Martin H Osmond, Terry P Klassen, George A Wells, Jennifer Davidson, Rhonda Correll, Kathy Boutis, Gary Joubert, Serge Gouin, Simi Khangura, Troy Turner, Francois Belanger, Norm Silver, Brett Taylor, Janet Curran, Ian G Stiell
BACKGROUND: There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. METHODS: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability...
July 9, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Nicholas Kramer, David Lebowitz, Michael Walsh, Latha Ganti
Deciding on proper medication administration for the traumatic brain injury (TBI) patient undergoing intubation can be daunting and confusing. Pretreatment with lidocaine and/or vecuronium is no longer recommended; however, high-dose fentanyl can be utilized to help blunt the sympathetic stimulation of intubation. Induction with etomidate is recommended; however, ketamine can be considered in the proper patient population, such as those with hypotension. Paralysis can be performed with either succinylcholine or rocuronium, with the caveat that rocuronium can lead to delays in proper neurological examinations due to prolonged paralysis...
April 25, 2018: Curēus
Maurizio Cecconi, Laura Evans, Mitchell Levy, Andrew Rhodes
Sepsis is a common condition that is associated with unacceptably high mortality and, for many of those who survive, long-term morbidity. Increased awareness of the condition resulting from ongoing campaigns and the evidence arising from research in the past 10 years have increased understanding of this problem among clinicians and lay people, and have led to improved outcomes. The World Health Assembly and WHO made sepsis a global health priority in 2017 and have adopted a resolution to improve the prevention, diagnosis, and management of sepsis...
June 21, 2018: Lancet
Eamonn Delahunt, Chris M Bleakley, Daniela S Bossard, Brian M Caulfield, Carrie L Docherty, Cailbhe Doherty, François Fourchet, Daniel T Fong, Jay Hertel, Claire E Hiller, Thomas W Kaminski, Patrick O McKeon, Kathryn M Refshauge, Alexandria Remus, Evert Verhagen, Bill T Vicenzino, Erik A Wikstrom, Phillip A Gribble
Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments...
June 9, 2018: British Journal of Sports Medicine
Yana Vinogradova, Carol Coupland, Trevor Hill, Julia Hippisley-Cox
OBJECTIVE: To investigate the associations between direct oral anticoagulants (DOACs) and risks of bleeding, ischaemic stroke, venous thromboembolism, and all cause mortality compared with warfarin. DESIGN: Prospective open cohort study. SETTING: UK general practices contributing to QResearch or Clinical Practice Research Datalink. PARTICIPANTS: 132 231 warfarin, 7744 dabigatran, 37 863 rivaroxaban, and 18 223 apixaban users without anticoagulant prescriptions for 12 months before study entry, subgrouped into 103 270 patients with atrial fibrillation and 92 791 without atrial fibrillation between 2011 and 2016...
July 4, 2018: BMJ: British Medical Journal
James F Holmes, Peter S Dayan, Nathan Kuppermann
Traumatic brain injury (TBI) is the leading cause of traumatic death in children. As many children with TBIs have subtle symptoms and missed or delayed diagnoses may result in increased morbidity, emergency department clinicians must frequently determine which children require emergent cranial computed tomographic (CT) scanning even after apparently minor blunt head trauma. Overuse of CT scans, however, has important drawbacks, including radiation-induced malignancies. Two large cohorts have documented the association of cranial CT scanning with cancer in children...
July 3, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Dawn Dalen, Amy Fry, Samuel G Campbell, Jeffrey Eppler, Peter J Zed
OBJECTIVE: The purpose of our study was to determine if cephalexin 500 mg orally four times daily was non-inferior to cefazolin 2 g intravenously daily plus probenecid 1 g orally daily in the management of patients with uncomplicated mild-moderate skin and soft tissue infection (SSTI) presenting to the ED. METHODS: This was a prospective, multicentre, double dummy-blind, randomised controlled non-inferiority trial conducted at two tertiary care teaching hospitals in Canada...
June 18, 2018: Emergency Medicine Journal: EMJ
Stephen Hearns
No abstract text is available yet for this article.
June 15, 2018: Emergency Medicine Journal: EMJ
Christopher J R Gough, Jerry P Nolan
Adrenaline has been used in the treatment of cardiac arrest for many years. It increases the likelihood of return of spontaneous circulation (ROSC), but some studies have shown that it impairs cerebral microcirculatory flow. It is possible that better short-term survival comes at the cost of worse long-term outcomes. This narrative review summarises the rationale for using adrenaline, significant studies to date, and ongoing research.
May 29, 2018: Critical Care: the Official Journal of the Critical Care Forum
Brit Long, Alex Koyfman, Eric J Chin
INTRODUCTION: Acute heart failure (AHF) accounts for a significant number of emergency department (ED) visits, and the disease may present along a spectrum with a variety of syndromes. OBJECTIVE: This review evaluates several misconceptions concerning heart failure evaluation and management in the ED, followed by several pearls. DISCUSSION: AHF is a heterogeneous syndrome with a variety of presentations. Physicians often rely on natriuretic peptides, but the evidence behind their use is controversial, and these should not be used in isolation...
June 1, 2018: American Journal of Emergency Medicine
Paul R Freund, Sylvia H Chen
No abstract text is available yet for this article.
May 28, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Audrey Wu
Heart failure affects more than 6 million people in the United States and incurs a heavy toll in morbidity, mortality, and health care costs. It frequently coexists with other important disorders, including hypertension, coronary artery disease, diabetes, and obesity. Decades of clinical trials have shown that several medications and interventions are effective for improving outcomes; however, mortality and hospitalization rates remain high. More recently, additional medications and devices have shown promise in reducing the health burden of heart failure...
June 5, 2018: Annals of Internal Medicine
Robert L Sheridan
No abstract text is available yet for this article.
June 2018: Pediatrics in Review
Christopher Bond, Justin Morgenstern, Corey Heitz, William K Milne
This systematic review provides an assessment of the excited delirium syndrome (ExDS), including definition, epidemiology, pathophysiology, and management. Sixty-six relevant articles were included with significant heterogeneity of selected studies and poor overall quality. A quantitative meta-analysis could not be performed because there remains no clear definition for ExDS, however, this study does provide useful information regarding epidemiology, pathophysiology, and treatment of ExDS.
June 1, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Bryan J Harvell, Stephen D Helmer, Jeanette G Ward, Elizabeth Ablah, Raymond Grundmeyer, James M Haan
Introduction: Recent studies have provided guidelines on the use of head computed tomography (CT) scans in pediatric trauma patients. The purpose of this study was to identify the prevalence of these guidelines among concussed pediatric patients. Methods: A retrospective review was conducted of patients four years or younger with a concussion from blunt trauma. Demographics, head injury characteristics, clinical indicators for head CT scan (severe mechanism, physical exam findings of basilar skull fracture, non-frontal scalp hematoma, Glasgow Coma Scale score, loss of consciousness, neurologic deficit, altered mental status, vomiting, headache, amnesia, irritability, behavioral changes, seizures, lethargy), CT results, and hospital course were collected...
May 2018: Kansas journal of medicine
Malcolm B Doupe, Dan Chateau, Alecs Chochinov, Ellen Weber, Jennifer E Enns, Shelley Derksen, Joykrishna Sarkar, Michael Schull, Ricardo Lobato de Faria, Alan Katz, Ruth-Ann Soodeen
STUDY OBJECTIVE: This study compares how throughput and output factors affect emergency department (ED) median waiting room time. METHODS: Administrative health care use records were used to identify all daytime (8 am to 8 pm) visits made to adult EDs in Winnipeg, Canada, between April 1, 2012, and March 31, 2013. First, we measured the waiting room time (from patient registration until transfer into the ED) of each index visit (incoming patient). We then linked each index visit to a group of existing patients surrounding it and counted the number of existing patients engaged in throughput processes (radiographs, computed tomography [CT] scans, advanced diagnostic tests) and one output process (waiting to be hospitalized)...
May 24, 2018: Annals of Emergency Medicine
Augustine S Lee, Jay H Ryu
Aspiration is a syndrome with variable respiratory manifestations that span acute, life-threatening illnesses, such as acute respiratory distress syndrome, to chronic, sometimes insidious, respiratory disorders such as aspiration bronchiolitis. Diagnostic testing is limited by the insensitivity of histologic testing, and although gastric biomarkers for aspiration are increasingly available, none have been clinically validated. The leading mechanism for microaspiration is thought to be gastroesophageal reflux disease, largely driven by the increased prevalence of gastroesophageal reflux across a variety of respiratory disorders, including chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis, and chronic cough...
June 2018: Mayo Clinic Proceedings
Maala Bhatt, David W Johnson, Monica Taljaard, Jason Chan, Nick Barrowman, Ken J Farion, Samina Ali, Suzanne Beno, Andrew Dixon, C Michelle McTimoney, Alexander Sasha Dubrovsky, Mark G Roback
Importance: It is not clear whether adherence to preprocedural fasting guidelines prevent pulmonary aspiration and associated adverse outcomes during emergency department (ED) sedation of children. Objective: To examine the association between preprocedural fasting duration and the incidence of sedation-related adverse outcomes in a large sample of children. Design, Setting, and Participants: We conducted a planned secondary analysis of a multicenter prospective cohort study of children aged 0 to 18 years who received procedural sedation for a painful procedure in 6 Canadian pediatric EDs from July 2010 to February 2015...
July 1, 2018: JAMA Pediatrics
Corey Heitz, Justin Morgenstern, Christopher Bond, William K Milne
This systematic review provides an assessment of the diagnostic accuracy of various historical, physical, and clinical examination features for aortic dissection. Nine articles were included, with moderate to high heterogeneity. Limitations to general practice include risk of selection bias and partial verification bias. Risk scores were included, but their use is not recommended at this time.
May 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2018-05-23 14:17:24
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