Classic EM Journal Reviews

August 8th, 2019 Leave a Comment

Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

Stroke is one of the leading causes of death in the United States. Approximately 87% of all strokes are ischemic. Available therapies are limited and include thrombolysis and thrombectomy. There is a known risk of hemorrhagic conversion of acute ischemic strokes with the use of thrombolytics. Of the 12 clinical trials comparing thrombolysis vs. either placebo or no treatment for acute ischemic stroke,
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Hyperbaric oxygen for acute carbon monoxide poisoning

Carbon monoxide is one of the most common causes of fatal poisoning through either intentional or unintentional exposure and accounts for almost 50,000 emergency departments per year. (Sircar 2015, PMID: 26032660) It is an odorless, colorless gas that is produced from relatively common sources such as vehicle exhaust, propane fueled heaters, wood/coal burning stoves and gasoline powered generators.
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Tags: , , February 6th, 2019 Leave a Comment

Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries

Prior to this study, the preoperative approach to hypotensive patients with trauma included prompt intravenous infusion of isotonic fluids – the rationale being to sustain tissue perfusion and vital organ function while diagnostic and therapeutic procedures were underway. This was based on animal studies in the 1950s that demonstrated isotonic-fluid resuscitation was an essential component of therapy for severe hypotension due to hemorrhage.  
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Tags: , September 18th, 2018 Leave a Comment

New Orleans Head CT Criteria

CT scans are frequently done after minor head injury to evaluate for intracranial hemorrhage. While CT scans are an excellent tool for diagnosing or ruling out this disorder, they are not without harms including radiation exposure, cost and department delays. Much of the time, CTs are negative, or find injuries for which no intervention is ever done and do not clinically affect the patient.
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Wells’ Score + D-dimer to Rule Out PE

In the US, pulmonary embolism (PE) kills 100,000 people each year and over 360,000 new cases of PE are diagnosed each year (Horlander 2003). Currently, the gold standard for diagnosing PE is the computed tomographic pulmonary angiography (CTPA). Patients with PE present with varying symptoms, from anxiety and tachycardia, to shortness of breath and syncope.
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Tags: , , , , August 2nd, 2018 Leave a Comment

Focused Echocardiographic Evaluation in Life Support and Peri-Resuscitation (FEEL Study)

Focused use of ultrasound in resuscitation of patients with shock and cardiac arrest has become increasingly embraced in both the emergency department (ED) as well as in the prehospital setting. Application of ultrasound, particularly of echocardiography, has the potential to identify treatable causes of shock and arrest, identify shockable rhythms and identify the presence of mechanical activity.
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Prospective Validation of the HEART Score

Chest pain representing acute coronary syndrome (ACS) is the most common reason patients presenting to the emergency department (ED) are admitted to the hospital. The treatment for ACS is early targeted therapy and missed cases results in increased morbidity and mortality. As a result many clinicians choose to admit patients for further evaluation, resulting in further testing and higher medical costs.
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Tags: , December 8th, 2016 Leave a Comment

Canadian Head CT Decision Tool

CT scans are frequently done after minor head injury to evaluate for intracranial hemorrhage. While CT scans are an excellent tool for diagnosing or ruling out this disorder, they are not without harms including radiation exposure, cost and department delays. Much of the time, CTs are negative, or find injuries for which no intervention is ever done and do not clinically affect the patient.
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