Cellulitis is a common emergency department (ED) presentation. Despite the fact that diagnosis remains relatively straight forward, complexity remains in management in terms of the causative agent and appropriate antibiotic regimen. Though beta-hemolytic Streptococci are the most common causative agents there is increasing prevalence of community acquired methicillin-resistant Staphylococcus aureus (MRSA). Cephalexin has long been used to treat uncomplicated cellulitis because of it’s activity against streptococci and methicillin-sensitive S.
Read More
Core Content edited by
Journal Review
Initial Antibiotic Choice in Uncomplicated Cellulitis
Core
Pelvic Vertical Shear Fractures
This week’s post explores the pelvic shear fracture focusing on identification + management.
Read More
Journal Review
Effect of Changing Post-ROSC Target Temperature
In 2002, the New England Journal of Medicine published two studies that changed the management of post-cardiac arrest patients by showing improved outcomes in patients treated with therapeutic hypothermia (32°C-34°C) for at least 24 hours. (Bernard 2002, Hypothermia 2002) The landscape changed again in 2013 with the publication of the Targeted Temperature Management (TTM) trial in the New England Journal,
Read More
Journal Review
Long-Term Outcomes in Submassive PE After Thrombolytics
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,
Read More
Core
Local Anesthetic Systemic Toxicity (LAST)
This post delves into local anesthetic systemic toxicity (LAST) syndrome with a focus on recognition and management.
Read More
Journal Review
Prognostic Value of Fever in Severe Sepsis and Septic Shock
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.
Read More
Core
Intertrochanteric Fractures
This post reviews the common intertrochanteric hip fracture focusing on diagnosis and management.
Read More
Journal Review
The Vitamin C, Thiamine and Hydrocortisone Cocktail in Sepsis
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.
Read More