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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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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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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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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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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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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Prior to the creation of the Ottawa Ankle Decision Instrument, most patients presenting to the Emergency room with a complaint of acute ankle injury had ankle and or foot radiographs ordered to evaluate for fracture, even though the incidence of fracture among this population is relatively low (~ 15%). While ankle radiographs do not expose the patient to large amounts of radiation,
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