EM Journal Update Journal Reviews

The “Syringe Technique” for TMJ Reduction

Acute nontraumatic temporomandibular joint (TMJ) dislocations are uncommon presentations in the ED that occur after excessive mouth opening. Common circumstances include laughing, yawning and dental extraction. The most common TMJ dislocation is the anterior form and reduction can be labor intensive, protracted and typically requires procedural sedation.
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Optimal First Line Analgesia in Ureteric Colic

Ureteric colic is a common cause of severe pain. Anecdotally, many patients describe it as “the worst pain” they’ve experienced. In the Emergency Department (ED) pain is typically treated with either a non-steroidal anti-inflammatory drugs (NSAIDs) or an opiate or a combination of both. There are limited high-quality studies investigating whether one medication is superior to another or whether the route of medication administration makes a difference.
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Amiodarone, Lidocaine or Placebo in OHCA

Out-of-hospital cardiac arrest (OHCA) leads to over 300,000 deaths every year in North America. Many OHCA are due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are generally considered to have the best prognosis during cardiac arrest due to their responsiveness to defibrillation. However, attempts at defibrillation during cardiac arrest frequently result in non-sustained return of spontaneous circulation (ROSC),
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Validity of Abdominal Exam in Blunt Trauma with Distracting Injuries

The past couple of decades have seen increased access to and ease of using CT scanning for traumatically injured patients. Given that the abdomen is an important source of occult bleeding, routine use of abdominal CT scans has become increasingly common and has predictably yielded many negative studies as well as finding clinically irrelevant abnormalities.
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Tags: , , May 19th, 2016 3 Comments

Bed-Up-Head-Elevated Position for Emergent Intubation

Emergent endotracheal intubation has risks of complications including hypoxia, pulmonary aspiration, and prolonged time to intubation. Previous studies from the anesthesiology literature suggests that bed-up head-elevated (BUHE) positioning is associated with improved glottic views and prolonged apnea time. Using this positioning method could lead to decreased complication rates with emergent intubation.
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Tags: , , May 12th, 2016 Leave a Comment

Irrigation of Cutaneous Abscesses

Irrigation after incision and drainage (I+D) of an abscess in the ED is considered by some sources to be standard care but local practice varies considerably. There are no randomized controlled trials to date that look at the potential benefits of this procedure. Irrigation increases the time required for the procedure and increases pain experienced by the patient.
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Tags: , , , May 5th, 2016 Leave a Comment

Rocuronium or Succinycholine for RSI in TBI

Airway management is a critical part of the management of patients presenting with traumatic brain injury (TBI). Emergency Physicians (EPs) have no ability to change the primary injury once it has occurred and so our focus is on preventing secondary brain injury. Hypoxemia and hypercarbia are major contributors to morbidity and mortality and management must focus on preventing them.
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Sensitivity of NCHCT < 6 Hours After Symptom Onset in Suspected SAH

Thanks to Salim Rezaie (@srrezaie) for peer-reviewing this post.

Acute headache is a common emergency department presentation that accounts for 1-2% of all encounters (Goldstein 2006) The differential includes many life-threatening diagnoses, one of which is aneurysmal subarachnoid hemorrhage (SAH). With an estimated overall prevalence of 2% and a 1-month mortality of 40-45%,
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