EM Journal Update Journal Reviews

Tags: , February 25th, 2016 Leave a Comment

Risks of Aggressive Reduction of Door-to-Balloon Time

The advent of percutaneous coronary intervention (PCI) led to a decrease in morbidity and in-hospital mortality for patients presenting with ST-elevation myocardial infarctions (STEMI). In 1999 the American College of Cardiology and American Heart Association updated their guidelines with the benchmark door-to-balloon time (DTB) to be less than 90 minutes. It has since been adopted as a measure of quality with many hospitals attempting to achieve faster times with the thought that shorter times will improve clinical outcomes.
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Tags: , , , February 18th, 2016 Leave a Comment

Identification of High-Risk ACS Patients Using POC Echo

Current American Heart Association (AHA) recommendations suggest that high-risk patients with unstable angina or NSTEMI should undergo early invasive intervention. Risk stratifying these patients generally relies on serial EKGs and troponins, which can delay findings and subsequent intervention as these tests require time and do not have optimal sensitivity or specificity.

Though not a traditional part of the Emergency Department (ED) workup,
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Tags: , February 11th, 2016 One Comment

Isopropyl Alcohol in the Treatment of Nausea

Nausea is a common complaint seen in the Emergency Department (ED). Although there are a number of agents available for treatment, the efficacy and safety of these drugs have recently come into question. Metoclopramide is a commonly used antiemetic agent but it carries significant side effects including akathesia and tardive dyskinesia. Ondansetron is another central acting drug that has been shown to be effective in nausea prophylaxis in patients receiving chemotherapy but has a black box warning due to its effect of prolonging the QT interval.
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Tags: , , , , February 4th, 2016 Leave a Comment

Lumbar Puncture After Normal NCHCT in Suspected Subarachnoid Hemorrhage

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%, SAH is a high-risk disease that no emergency physician wants to miss (Linn 1996).
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Tags: , , January 28th, 2016 Leave a Comment

NEXUS Chest Decision Instruments

CT use in the evaluation of trauma patients has risen dramatically in recent years. “Pan-scan” (CT scan from head through pelvis) is used routinely in many trauma centers in spite of the American College of Surgeons inclusion of avoidance of routine whole body CT in trauma in it’s Choosing Wisely recommendations. Although prior studies have demonstrated increased identification of traumatic pathology with “pan-scanning” there has not been a concurrent demonstration of decreased morbidity or mortality.
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Tags: , , January 21st, 2016 Leave a Comment

Idarucizumab for Reversal of Dabigatran

Dabigatran Site of Action (www.medscape.com)

The burdens associated with the use of traditional anticoagulants such as subcutaneous heparins and oral vitamin K antagonists (VKAs) have spurred the popularity of non-vitamin K oral anticoagulants (NOACs) for stroke prevention in patients with nonvalvular atrial fibrillation and for the prevention and treatment of venous thromboembolism.
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Tags: , January 14th, 2016 Leave a Comment

ED Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence

The harmful effects of opioid dependence are well known to ED providers and include overdose, high risk behaviors, and psychosocial instability. Patients with opioid dependence represent a significant proportion of ED visits annually, whether for overdose, addiction/withdrawal treatment, or general medical and psychiatric care. Previous studies have shown that buprenorphine/naloxone, a partial opioid agonist + antagonist,
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Tags: , , January 7th, 2016 Leave a Comment

Treatment of Acute, Non-Traumatic Low Back Pain

Acute, non-traumatic low back pain (LBP) is a common chief complaint and has been estimated to lead to more than 2.7 million ED visits annually nationwide. It affects a broad range of individuals and can be painful and debilitating long after an initial ED visit. Often times in clinical practice, evidence based decisions on medical management of acute lower back pain seem to be thrown out the window;
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