Classic EM Journal Reviews

Tags: , , , November 22nd, 2021 Leave a Comment

D-Dimer to Rule Out Venous Thromboembolism During Pregnancy: A Systematic Review and Meta-Analysis

Pregnant women have a higher risk of venous thromboembolism (VTE) and an increasing D-Dimer over the course of pregnancy. The majority of clinical guidelines recommend the D-dimer should not be used to assess the risk of VTE in pregnant women. However, CTPE presents a radiation risk to both the mother and fetus. Unfortunately, most VTE studies exclude pregnant women.
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Tags: , September 13th, 2019 Leave a Comment

Dexamethasone in Adults with Bacterial Meningitis

Morbidity and mortality rates are high among adult patients with acute bacterial meningitis especially those with pneumococcal meningitis. Animal studies have shown that bacterial lysis occuring with antibiotic treatment leads to inflammation in the subarachnoid space and that treatment with dexamethasone, an anti-inflammatory agent, reduced cerebrospinal fluid inflammation and neurologic sequelae (Tauber, et al., J Infect Dis.,
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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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