Sore throat is among the most common complaints in the emergency department (ED). Sometimes, the etiology is bacterial, and in those cases antibiotics may shorten the duration of disease and provide symptomatic relief. The majority of cases are viral and though most are appropriately treated with symptom management in the forms of NSAIDS and acetaminophen,
Read More
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,
Read More
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.
Read More
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.
Read More
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.
Read More
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.
Read More
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.
Read More
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.
Read More