EM Journal Update Journal Reviews

Tags: , , , December 31st, 2015 One Comment

The Predictive Ability of the FAST Examination in Traumatic Cardiac Arrest

Resuscitative thoracotomy (RT) performed in the Emergency Department (ED) is a potentially life-saving procedure in patients with traumatic cardiac arrest. However, the procedure does have the potential to harm providers (i.e. fluid exposure). Therefore, it is important to weight two different perspectives: the patient is dead and will remain so if an RT is not performed so why not try it as a last ditch effort and that RT is low yield so why expend resources and create a potential risk of harm to providers. 
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Tags: , December 17th, 2015 Leave a Comment

Prophylactic Antibiotics in Fingertip Amputations

Fingertip amputations are common. Treatment options range from healing by secondary intention to flap coverage or replantation. Selection of the appropriate treatment modality depends on the nature of the injury, the physical demands of the patient, and the patient’s co-morbidities. Prophylactic antibiotic use in patients with fingertip amputations is controversial. The routine use of prophylactic antibiotics is universally recommended on grossly contaminated wounds,
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Tags: , , , December 10th, 2015 Leave a Comment

The HEAT Trial – Acetaminophen in Critical Illness

This review was cross-posted on REBEL EM.

Acetaminophen (paracetamol) is commonly used to lower the temperature of patients with fever suspected to be cause d by an infection in both homes across the world and the hospital. There are, however, opposing theories to the utility of decreasing fever in these situations. One side argues that fever places “additional physiological stress on patients,” who are already ill (Young 2015).
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Tags: , , , December 3rd, 2015 Leave a Comment

Lactate in Critically Ill Patients with UGIB

Within the Emergency Department (ED), rapid identification and stabilization of critically ill patients with upper gastrointestinal bleeding (UGIB) is essential to patient survival. While there are some clinical prediction scores, ED physicians most often depend on clinical gestalt when risk stratifying and managing these patients. The most commonly used scores are the Glasgow-Blatchford score, AIMS65 and the Rockall score.
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Tags: , , November 26th, 2015 3 Comments

Ultrasound Guided Fluid Assessment Protocol

In critically ill patients, fluid status is a balancing act. Too little fluid resuscitation can lead to end organ hypoperfusion, while too much fluid resuscitation can lead to pulmonary edema and respiratory compromise. In some situations, it is difficult to differentiate who will benefit from more fluids and who will be fluid unresponsive or even require fluid restriction.
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Tags: November 19th, 2015 Leave a Comment

Intravascular Complications of Central Line by Insertion Site

Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for complications including infection, thrombosis and mechanical dysfunction (pneumothorax, hematoma). The authors’ previous research led them to believe that these complications will differ according to the site of insertion.
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Tags: , , November 12th, 2015 Leave a Comment

REVERT – The Modified Valsalva Maneuver

Supraventricular tachycardias (SVT) (excluding atrial fibrillation and atrial flutter) are common cardiac arrhythmias leading to presentation to the Emergency Department (ED). The Valsava maneuver is a recommended first-line method to cardiovert stable patients, but its reported efficacy is low (5-20%). Chemical cardioversion agents can have unpleasant side effects and require intravenous access. Increasing the success rate from the Valsava maneuver could lead to increased patient comfort and decreased resource utilization.
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Tags: , , November 5th, 2015 Leave a Comment

Ketamine vs. Morphine in Acute Pain Management

Ketamine, a noncompetitive N-methyl-D-asparate and glutamate receptor antagonist, is a Phencyclidine-like dissociative agent that possesses potent analgesic, anxiolytic and amnestic properties. In the Emergency Department (ED), ketamine is commonly used for procedural sedation. Outside of the ED, subdissociative doses (0.3 mg/kg), have been successfully used as an adjunct to opiate refractory pain. Recent data has shown that subdissociative doses of ketamine may be comparable to morphine as a first-line agent in out-of-hospital settings.
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