Core Journal Reviews

Fever without source in infants less than three months old presents a difficult diagnostic dilemma for ED physicians.  Over the past 25 years several algorithms have been developed to help guide clinicians, most notably the Rochester, Philadelphia and Boston Criteria, in determining which infants require admission vs. outpatient management.  These studies were designed published between 1992 and 1994 prior to the wide spread use of HiB and pneumococcal vaccines in children,
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Within the US, chest pain is the most common etiology for observation and short inpatient stays.  Patients are admitted to assess for the presence of serious pathology including acute coronary syndrome (ACS). To decrease short inpatient stays, institutions have transitioned to observational status and those patients are considered outpatients. The impact of this change on resource utilization and patient outcomes continues to be unclear.
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This post is cross posted on REBEL EM.

Intubation and mechanical ventilation are commonly performed ED interventions and although patients optimally go to an ICU level of care afterwards, many of them remain in the ED for prolonged periods of time. It is widely accepted that the utilization of lung-protective ventilation reduces ventilator-associated complications including acute respiratory distress syndrome (ARDS).
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Filed Under: Tags: , , June 1st, 2017 Leave a Comment

This post is cross-posted on REBEL EM.

Post-partum hemorrhage (PPH) is the leading cause of maternal death worldwide. It is typically defined as > 500 ml of blood loss within 24 hours of giving birth. However, PPH encompasses a broad spectrum of disease from mild oozing over hours to rapid exsanguination and death.
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Filed Under: Tags: , , May 25th, 2017 Leave a Comment

The two most important things that we can do in cardiac arrest to improve survival and neurologically intact outcomes is high quality CPR, with limited interruptions and early defibrillation. The 2015 AHA/ACC CPR updates recommended a compression rate of 100 -120/min, a depth of 2 – 2.4in, allowing full recoil, and minimizing pauses. This is a lot to remember during a stressful code situation and one way many providers are offloading themselves cognitively is by the use of mechancical CPR (mCPR) devices. 
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This post is cross-posted on REBEL EM here.

Etomidate and ketamine are both routinely used as induction agents during rapid sequence intubation (RSI) in trauma patients. It is well established that etomidate transiently suppresses the adrenal gland through inhibition of the 11-beta hydroxylase enzyme. Though adrenal suppression in theory can cause deleterious outcomes,
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Filed Under: Tags: , May 11th, 2017 Leave a Comment

The Emergency Department, by its nature, is interruption driven given it is “uncontrolled and unpredictable and punctuated by intermittent time-critical activities (Chisholm 2000). On average, each Emergency Physician is interrupted 6.6 times per hour while at work; 11 percent of all tasks were interrupted, 3.3 percent of them more than once (Westbrook 2010). One study (Westbrook 2010) calculated that physicians were multitasking 12.8 percent of the time,
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In patients with subarachnoid hemorrhage, one of the major early complications is rebleeding, with reported incidences ranging from 8% to 23% in the first 72 hours (Larsen 2010).  If repair of the ruptured aneurysm is performed successfully in a timely fashion, the chance of rebleeding can be decreased, thereby decreasing morbidity and mortality in these patients. 
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