EM Journal Update Journal Reviews

Balanced Solutions vs 0.9% Saline in Critical Care (SMART)

Although 0.9% sodium chloride (“normal” saline) is traditionally the most commonly used intravenous fluid, it is unclear if “normal” saline is the best fluid. Data from prior studies suggests 0.9% saline use may result in hyperchloremic acidosis. Additionally, 0.9% saline is associated with the development of acute kidney injury (AKI). There have been several observational studies and a before-and-after trial comparing 0.9% saline and “balanced” crystalloids like lactated Ringer’s and Plasma-Ltye A,
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The VAN Assessment to Identify Large Vessel Occlusion Strokes

This review is cross-posted on REBEL EM.

Over the last three years, we have seen the rise of neurointerventional therapies for patients with ischemic strokes due to large vessel occlusions (LVOs). This group of strokes typically includes patients with occlusion of the distal intracranial carotid artery, middle cerebral artery or anterior cerebral artery.
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May 10th, 2018 Leave a Comment

SALT-ED: Balanced Solutions vs 0.9% Saline in the ED

Intravenous fluid administration is a staple of modern medical care. The advantage of crystalloid over colloid solutions is well established in the literature. However, few studies have examined differences in outcomes between “normal” saline solution (0.9% NaCl) and more “balanced” solutions such a Ringer’s Lactate or Plasma-Lyte A, which seek to more closely replicate “physiologic” conditions.
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ADRENAL – Corticosteroids in Septic Shock

During physiological stress, hypotension, or severe infection, the hypothalamic-pituitary-adrenal (HPA) axis is activated. The hypothalamus secretes corticotrophin-releasing hormone (CRH) stimulating the release of adrenocorticotrophin hormone (ACTH) from the anterior pituitary. This results in cortisol secretion from the adrenal glands, and as a result, serum cortisol increases.

Endogenous cortisol is thought to have many benefits in physiologic stress1.
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Tags: , , April 26th, 2018 Leave a Comment

The HEAVEN Difficult Airway Prediction Tool

This review was previously posted on REBEL EM here.

Predicting an anatomically and/or physiologically challenging airway is not a straightforward task by any stretch of the imagination.  There are some existing difficult-airway prediction tools available (i.e. LEMON = Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck mobility), but many of them were derived in an elective surgery setting and may not be as applicable to emergency airway management. 
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Tags: , April 19th, 2018 Leave a Comment

PE Rule-Out Criteria RCT

The diagnosis of a pulmonary embolism (PE) in the Emergency Department (ED) is complicated. Many different decision rules have been developed to help risk stratify patients coming into the ED with some level of suspicion for PE.  The Pulmonary Embolism Rule-Out Criteria (PERC) are a set of decision rules created to reduce testing in patients who have a low probability of PE.
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Tags: , , , April 12th, 2018 Leave a Comment

Door-to-Furosemide Time

Acute congestive heart failure (AHF) results in nearly 1 million emergency department (ED) visits in the US per year and is associated with high morbidity, mortality, and cost.  It is increasingly clear that ED management of these patients may determine later in-hospital mortality and ultimate prognosis.
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Tags: , , April 5th, 2018 Leave a Comment

Utility of quick sepsis-related organ failure assessment (qSOFA) to predict outcome in patients with pneumonia

Pneumonia, an acute infection of the pulmonary parenchyma, is a disease that commonly presents to US Emergency Departments, with an incidence as high as 9.7 per 1000 persons in developed countries.  Studies have found that community acquired pneumonia alone has a hospitalization rate of 46.5% and 30-day mortality of 12.9%, with a case fatality rate of over 50% in patients with pneumonia-related sepsis/septic shock (Kolditz 2016, 
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