In critically ill patients, fluid status is a balancing act. Too little fluid resuscitation can lead to end organ hypoperfusion, while too much fluid resuscitation can lead to pulmonary edema and respiratory compromise. In some situations, it is difficult to differentiate who will benefit from more fluids and who will be fluid unresponsive or even require fluid restriction.
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Journal Review
Ultrasound Guided Fluid Assessment Protocol
Journal Review
Intravascular Complications of Central Line by Insertion Site
Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for complications including infection, thrombosis and mechanical dysfunction (pneumothorax, hematoma). The authors’ previous research led them to believe that these complications will differ according to the site of insertion.
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Core
Acromioclavicular (AC) Joint Injuries
AC joint injuries are commonly encountered in upper extremity injuries. This post reviews physical exam, x-ray findings and management.
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Journal Review
REVERT – The Modified Valsalva Maneuver
Supraventricular tachycardias (SVT) (excluding atrial fibrillation and atrial flutter) are common cardiac arrhythmias leading to presentation to the Emergency Department (ED). The Valsava maneuver is a recommended first-line method to cardiovert stable patients, but its reported efficacy is low (5-20%). Chemical cardioversion agents can have unpleasant side effects and require intravenous access. Increasing the success rate from the Valsava maneuver could lead to increased patient comfort and decreased resource utilization.
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Journal Review
Ketamine vs. Morphine in Acute Pain Management
Ketamine, a noncompetitive N-methyl-D-asparate and glutamate receptor antagonist, is a Phencyclidine-like dissociative agent that possesses potent analgesic, anxiolytic and amnestic properties. In the Emergency Department (ED), ketamine is commonly used for procedural sedation. Outside of the ED, subdissociative doses (0.3 mg/kg), have been successfully used as an adjunct to opiate refractory pain. Recent data has shown that subdissociative doses of ketamine may be comparable to morphine as a first-line agent in out-of-hospital settings.
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Core
Approach to Traumatic Shoulder Pain
This post reviews the basic approach to assessment of the traumatic shoulder injury. Subsequent posts will focus in on specific pathologies.
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Journal Review
H. pylori Testing in the ED
Abdominal pain is the most frequent presenting symptom in US emergency departments. The current standard care in the ED for upper abdominal pain involves ruling out severe causes (i.e. biliary disease, perforated viscous etc) and consideration of empiric gastric disease treatment with histamine blockers, antacids, or proton-pump inhibitors.
H. pylori is a bacterium that infects the stomach causing dyspepsia.
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Journal Review
Age Adjusted D-dimer in PE – The ADJUST-PE Study
Background
Acute pulmonary embolism (PE) is a common disease associated with high degrees of morbidity and mortality. The D-dimer assay has the potential to be a valuable test in the workup of PE as it is sensitive for thrombus formation. Unfortunately, specificity is low and indiscriminate use can lead to increased advanced imaging.
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