Risk stratification tools like the Well’s and Geneva scores are useful for identifying patients in whom a venous thromboembolism (VTE) can be excluded with a negative D-dimer. This allows for decreased utilization of computed tomographic pulmonary angiography, V/Q scans and lower limb ultrasounds. However, the poor specificity of the D-dimer is associated with more patients getting imaged and the increased identification of sub-segmental clots of questionable significance.
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Thanks to Salim Rezaie for the peer review. This post is cross-posted at REBEL EM.
Low back pain is an extremely common presentation to US Emergency Departments (EDs) representing 2.4% or 2.7 million visits annually. The vast majority of presentations are benign in etiology but can be time consuming and frustrating for both patients and physicians.
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Observation units (OUs) are a hot topic in Emergency Medicine (EM) today. They are expanding their presence among hospitals, and their footprint within hospitals, every day (Feng 2013). The reason for this is multifactorial, but is almost always a response to cost and policy challenges. First, OUs present reductions in cost for hospitals, as they are cheaper than full inpatient stays and often include shorter length of stays.
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Intravenous (IV) iodinated contrast media is used routinely to improve the accuracy of computed tomography (CT) in the emergency department (ED). Prior studies have linked contrast media with the development of acute kidney injury (AKI) and has been linked to increased risk of major adverse events including the initiation of dialysis, renal failure, stroke, myocardial infarction and death.
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In 2016 the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), redefined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This group postulated that sepsis can be identified through an increase in Sequential Organ Failure Assessment (SOFA) score of at least 2 points. The quick SOFA (qSOFA) score is a simplified tool that includes respiratory rate >21 breaths/min,
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Atrial fibrillation (AF) is one of the most common dysrhythmias encountered in the ED. The management of recent-onset AF and atrial flutter (AFl) in the ED continues to be debated. The discussion centers on whether patients with recent-onset AF should be rhythm controlled (e.g. converted back to sinus rhythm) or rate controlled only. This debate was showcased in a point-counterpoint in Annals of Emergency Medicine in 2011 (Stiell 2011,
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Intravenous (IV) nitroglycerin (NTG) infusion is one of the mainstay treatments in acute pulmonary edema (aka acute decompensated heart failure (ADHF)), but is associated with increased hospital length of stay (LOS) and health care costs. Optimal NTG dosing isn’t established though physiologically, higher infusion doses (> 100 mcg/min) are helpful as they affect both afterload and preload.
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