Core Journal Reviews

There is scant evidence published on the long-term outcomes of systemic thrombolysis in acute submassive PE.  Many advocate for the use of systemic thrombolysis to reduce morbidity (complications from chronic pulmonary hypertension) and mortality. The PEITHO trial compared systemic thrombolysis (with tenecteplase + heparin) vs no systemic thrombolysis (placebo + heparin) in just over 1000 patients with confirmed PE,
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Filed Under: Tags: July 13th, 2017 Leave a Comment

Sepsis remains a condition with a high mortality rate, and prompt recognition of the condition is essential. The presence and severity of fever raises suspicion for infection and is frequently a significant factor in medical decision making in the Emergency Department (ED). However, many septic patients are not febrile, which can impede prompt identification of critically ill patients.
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While early recognition and treatment of sepsis has improved outcomes, mortality rates continue to be high. In low income countries, septic patients suffer mortality rates as high as 60%. Sepsis has been associated with vitamin c deficiency, with lower levels of vitamin c being associated with higher mortality rates. Prior studies targeting pathophysiological effects of sepsis have failed.
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Filed Under: Tags: , , June 29th, 2017 Leave a Comment

Asthma is a disease entity that all emergency department (ED) providers are expected to be able to manage both quickly and effectively. This is especially true in the pediatric population, where asthma is both the most common chronic disease of childhood and a leading reason for children to present to the ED.

In addition to mainstay therapies like beta-agonist inhalers and systemic steroids,
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Fever without source in infants less than three months old presents a difficult diagnostic dilemma for ED physicians.  Over the past 25 years several algorithms have been developed to help guide clinicians, most notably the Rochester, Philadelphia and Boston Criteria, in determining which infants require admission vs. outpatient management.  These studies were designed published between 1992 and 1994 prior to the wide spread use of HiB and pneumococcal vaccines in children,
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Within the US, chest pain is the most common etiology for observation and short inpatient stays.  Patients are admitted to assess for the presence of serious pathology including acute coronary syndrome (ACS). To decrease short inpatient stays, institutions have transitioned to observational status and those patients are considered outpatients. The impact of this change on resource utilization and patient outcomes continues to be unclear.
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This post is cross posted on REBEL EM.

Intubation and mechanical ventilation are commonly performed ED interventions and although patients optimally go to an ICU level of care afterwards, many of them remain in the ED for prolonged periods of time. It is widely accepted that the utilization of lung-protective ventilation reduces ventilator-associated complications including acute respiratory distress syndrome (ARDS).
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Filed Under: Tags: , , June 1st, 2017 Leave a Comment

This post is cross-posted on REBEL EM.

Post-partum hemorrhage (PPH) is the leading cause of maternal death worldwide. It is typically defined as > 500 ml of blood loss within 24 hours of giving birth. However, PPH encompasses a broad spectrum of disease from mild oozing over hours to rapid exsanguination and death.
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