EM Journal Update Journal Reviews

Tags: , , , July 19th, 2018 Leave a Comment

ACEP Venous Thromboembolism Clinical Policy 2018

The evaluation and management of venous thromboembolism (VTE) in the Emergency Department (ED) is fraught with questions: who should I evaluate, who should get a d-dimer, what should the d-dimer threshold be etc. Answers, unfortunately, are far less common. Due to the enormous volume of literature produced on the topic, it can be difficult for individual clinicians to incorporate all of the information into a comprehensive approach.
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Tags: , , July 12th, 2018 Leave a Comment

High-Flow Nasal Canula in Bronchiolitis

This analysis was originally posted on REBEL EM here

Bronchiolitis is an acute inflammatory injury of the distal smaller airways, most commonly caused by viral infections.  There have been a host of medications studied in the treatment of bronchiolitis, including steroids, albuterol, epinephrine, and  inhaled hypertonic saline, with none proving to be effective in treatment. 
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Video vs Direct Laryngoscopy in the Emergency Department

This analysis was originally posted on REBEL EM here

Endotracheal intubation is a common occurrence in the Emergency Department (ED). Many patients requiring airway management are at a higher risk of hypoxia due to deranged respiratory physiology (i.e. decreased functional residual capacity and/or increased shunt fraction).  Advocates of VL argue that it provides better visualization of the airway anatomy,
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NaHCO3 in Cardiac Arrest

As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s role in patients with acidemia resulting from or causing arrest is unclear. In theory,
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Utility of Adjunct Antibiotics After I+D – Systematic Review + Meta-Analysis

Skin and soft tissue abscesses are a common emergency department (ED) presentation. The approach to management has changed little in recent decades: incision and drainage (I+D) and then discharge home with follow up. However, increasing rates of methicillin-resistant staph aureus (MRSA) over the last decade have led to further consideration of adjunct therapy with oral antibiotics to improve cure rates.
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Tenecteplase vs Alteplase Before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK)

This review is cross-posted on REBEL EM.

Alteplase is a tissue plasminogen activator that is approved for use prior to thrombectomy in ischemic strokes with the goal of reperfusion to ischemic areas of the brain. Tenecteplase is a recombinant enzyme derived from alteplase that is more specific to fibrin and more resistant to inactivation by alteplase inhibitors.
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Succinylcholine vs. Rocuronium for 1st Pass Success Rate

This post was also featured on REBEL EM.

Administration of a neuromuscular blocker (NMB) is an essential part of Emergency Department  (ED) airway management for facilitating ideal airway conditions and is most commonly performed with either succinylcholine or rocuronium. Despite extensive debates between providers, one agent has not been shown to be superior to other.
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Tags: , , May 31st, 2018 Leave a Comment

Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis

Sore throat is among the most common complaints in the emergency department (ED). Sometimes, the etiology is bacterial, and in those cases antibiotics may shorten the duration of disease and provide symptomatic relief. The majority of cases are viral and though most are appropriately treated with symptom management in the forms of NSAIDS and acetaminophen,
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