This post explores the presentation, diagnosis and management of salicylate toxicity.
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Salicylate Toxicity (Salicylism)
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Post-It Pearls 12.0
Teaching on a clinical shift can sometimes be difficult: it’s busy, everyone’s running around and it’s hard to capture a trainees attention. Recently, on twitter, Amal Mattu (@amalmattu) has been posting pictures of his white board teaching: discrete pearls written down and shared with anyone who walks by. The pearls are often prompted by patients presenting during that shift but they don’t have to be.
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Journal Review
ADRENAL – Corticosteroids in Septic Shock
During physiological stress, hypotension, or severe infection, the hypothalamic-pituitary-adrenal (HPA) axis is activated. The hypothalamus secretes corticotrophin-releasing hormone (CRH) stimulating the release of adrenocorticotrophin hormone (ACTH) from the anterior pituitary. This results in cortisol secretion from the adrenal glands, and as a result, serum cortisol increases.
Endogenous cortisol is thought to have many benefits in physiologic stress1.
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Core
Petition to Retire the Surviving Sepsis Campaign Guidelines
This post is a multi-physician, multi-specialty petition detailing significant concerns with the surviving sepsis campaign guidelines.
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Journal Review
The HEAVEN Difficult Airway Prediction Tool
This review was previously posted on REBEL EM here.
Predicting an anatomically and/or physiologically challenging airway is not a straightforward task by any stretch of the imagination. There are some existing difficult-airway prediction tools available (i.e. LEMON = Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck mobility), but many of them were derived in an elective surgery setting and may not be as applicable to emergency airway management.
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Journal Review
PE Rule-Out Criteria RCT
The diagnosis of a pulmonary embolism (PE) in the Emergency Department (ED) is complicated. Many different decision rules have been developed to help risk stratify patients coming into the ED with some level of suspicion for PE. The Pulmonary Embolism Rule-Out Criteria (PERC) are a set of decision rules created to reduce testing in patients who have a low probability of PE.
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Core
Jones Fractures
This post reviews the common Jones fracture (base of the 5th metatarsal) and some pearls + pitfalls in management.
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Journal Review
Door-to-Furosemide Time
Acute congestive heart failure (AHF) results in nearly 1 million emergency department (ED) visits in the US per year and is associated with high morbidity, mortality, and cost. It is increasingly clear that ED management of these patients may determine later in-hospital mortality and ultimate prognosis.
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