Risk stratification tools like the Well’s and Geneva scores are useful for identifying patients in whom a venous thromboembolism (VTE) can be excluded with a negative D-dimer. This allows for decreased utilization of computed tomographic pulmonary angiography, V/Q scans and lower limb ultrasounds. However, the poor specificity of the D-dimer is associated with more patients getting imaged and the increased identification of sub-segmental clots of questionable significance.
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Journal Review
Age-Adjusted D-dimer (Using D-dimer Units)
Post
Post-It Pearls 7.0
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
Effectiveness of Diazepam Adjunct Therapy in Acute Low Back Pain
Thanks to Salim Rezaie for the peer review. This post is cross-posted at REBEL EM.
Low back pain is an extremely common presentation to US Emergency Departments (EDs) representing 2.4% or 2.7 million visits annually. The vast majority of presentations are benign in etiology but can be time consuming and frustrating for both patients and physicians.
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Pediatric Septic Hip
This posts discusses the identification and management of the pediatric septic hip as well as differentiation from toxic synovitis.
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MDCalc App Launches for Android
EBM is under attack. The Trump administration has signaled it will de-regulate the FDA, lowering the current threshold of safety & efficacy. This may bring us closer to the pharmaceutical disasters of the past: the children of Thalidomide, snake oil salesmen selling heal-all elixirs, Bayer’s invention & marketing of Heroin as a non-addictive cough suppressant,
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Journal Review
Observation Units Reduce Admissions and Discharges Home
Observation units (OUs) are a hot topic in Emergency Medicine (EM) today. They are expanding their presence among hospitals, and their footprint within hospitals, every day (Feng 2013). The reason for this is multifactorial, but is almost always a response to cost and policy challenges. First, OUs present reductions in cost for hospitals, as they are cheaper than full inpatient stays and often include shorter length of stays.
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Finger Injuries
This week’s post focuses on common soft-tissue finger injuries with a focus on diagnosis and management.
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Journal Review
Acute Kidney Injury is not Associated with IV Contrast Use in the ED
Intravenous (IV) iodinated contrast media is used routinely to improve the accuracy of computed tomography (CT) in the emergency department (ED). Prior studies have linked contrast media with the development of acute kidney injury (AKI) and has been linked to increased risk of major adverse events including the initiation of dialysis, renal failure, stroke, myocardial infarction and death.
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