The simplified PE Severity Index (sPESI) is one of several validated prognostic tools for acute pulmonary embolism (PE). The European Society of Cardiology recommended the use of the sPESI to risk-stratify patients with acute PE into low risk (sPESI=0) and non-low risk (sPESI≥1) in order to guide treatment and disposition (Konstantinides 2014). Systematic reviews and meta-analyses have found that outpatient management of low-risk PE patients with standard therapy is safe,
Read More
Tachycardia is a very common abnormal vital sign in the Pediatric Emergency Department (ED). Tachycardia can have numerous underlying causes including less concerning clinical states such as fever, pain, and anxiety but can also be a sign of impending cardiovascular decompensation which occurs in shock, sepsis, and cardiac dysfunction.
Read More
The provision of high-quality compressions with minimal interruptions is central to the management of cardiac arrest. Along with defibrillation, high-quality compressions are the only interventions proven to improve patient-oriented outcomes. Recently, point-of-care ultrasound (POCUS) has gained greater use in cardiac arrest care for determination the cause of arrest as well as guiding the resuscitation and interventions.
Read More
In 2016 the annual incidence of out-of-hospital cardiac arrest (OHCA) in the United States was roughly 360,000 and 209,000 for in-hospital cardiac arrest (IHCA) (Mozaffarian 2016). Though survival rates are relatively dismal, arrests in the setting of shock amenable rhythms – ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) – have an overall better rate of return of spontaneous circulation (ROSC).
Read More
Skin and soft tissue infections (SSTI), specifically skin abscesses, are an increasingly common cause for emergency department (ED) visits. Many of these are uncomplicated and are treated in the ED with incision and drainage (I&D) and then discharged. In an era of increasing rates of methicillin-resistant staph aureus (MRSA), there may be a role for adjunct therapy with oral antibiotics to improve cure rates.
Read More
Patients with end of life care needs frequently present to emergency departments (EDs) throughout the world, whether for life sustaining treatments, symptomatic relief or social needs.Previous research has demonstrated that these patients and their families often do not have their expectations of care met by the ED, and furthermore, may even experience greater suffering. Emergency medicine (EM) physicians and nurses may not be adequately trained to deal with this specific patient population,
Read More
Anaphylaxis is an acute, potentially life-threatening emergency. In patients with compromise of their airway, breathing or circulation, epinephrine (epi) should be rapidly administered. There is little data describing the differences in epi administration and cardiac complications among older and younger patients with anaphylaxis. Older patients have been identified as a vulnerable group for severe or fatal anaphylaxis.
Read More
Recent years have seen a paradigm shift in cardiac arrest from the traditional mantra of airway, breathing circulation (ABC’s) to circulation, airway, breathing (CAB). This change represents the understanding that circulation is of paramount importance and thus, advanced airway management has been de-emphasized. This change is rational as the only interventions that have been shown to be beneficial in cardiac arrest are high-quality CPR and defibrillation.
Read More