Core Journal Reviews

Filed Under: Tags: , , January 18th, 2018 Leave a Comment

Since 2000, there have been over 500,000 opioid related overdose deaths in the US. (Burke 2016).  Despite the epidemic of opioid deaths, these drugs continue to be used as first line agents for treatment of moderate to severe pain in Emergency Departments (EDs). While demonstration that ED use of an opiate causes future abuse and morbidity/mortality does not exist,
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Filed Under: Tags: , , January 11th, 2018 Leave a Comment

Cardiac CT Angiography (CCTA) is a promising imaging technique that detects stenosis of the coronary arteries quickly and accurately. It can also detect other causes of chest pain when patients present to the emergency department (ED). Several studies have shown that patients with normal cardiac CCTA results are at low risk for adverse events (Oostema 2012).
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Filed Under: Tags: , January 4th, 2018 Leave a Comment

Acute Aortic Syndromes (AAS) are life threatening cardiovascular emergencies that are the bane of every emergency physician’s existence.  They are diagnostic challenges due to the clinical presentation being highly non-specific.  Computed tomography angiography (CTA), Transesophageal Echocardiography (TEE), and Magnetic Resonance Angiography (MRA) can help accurately diagnose AAS. CTA exposes patients to radiation and large doses of intravenous contrast,
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Filed Under: Tags: December 28th, 2017 Leave a Comment

Thanks to Sergey Motov (@PainFreeED) for the expert review at the end of the post.

Acute, minor musculoskeletal injuries (i.e. non-fracture or dislocations) are frequently seen in the Emergency Department. Aside from ruling out a more severe injury, management often focuses on pain relief or mitigation of pain. Though many analgesic agents exist,
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Assessing fluid responsiveness is essential to guiding resuscitation of critically ill patients. Inferior vena cava (IVC) collapsibility measured by point of care ultrasound (POCUS) has been shown to accurately predict fluid responsiveness in mechanically ventilated patients. However, it’s utility in spontaneously breathing patients is less well established.
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First trimester vaginal bleeding is a common complaint seen in the Emergency Department (ED).  Patients are obviously stressed about the possibility of miscarriage while providers are stressed about missing diagnoses such as ectopic pregnancies.  There have been multiple studies questioning the interrater reliability of the pelvic examination. But is there added utility to the examination once the presence of an intrauterine pregnancy (IUP) has been established?
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Ascites is the most common complication of liver cirrhosis, and infection of that abdominal fluid, spontaneous bacterial perotinitis (SBP) is both common (reported in 10-30% of hospitalized patient) and deadly, with a mortality rate of 10%. SBP can be diagnosed by analysis of ascitic fluid obtained by a simple bedside diagnostic paracentesis, a procedure well within the scope of all emergency medicine physicians.
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Filed Under: Tags: , November 30th, 2017 Leave a Comment

Abusive head trauma is the leading cause of death from child abuse and the leading cause of death from traumatic brain injury. Identification of clinically important traumatic brain injury is essential. The PECARN head trauma rule for children less than 2 years of age includes 6 predictors (PECARN 2009). The predictors of “acting normally as per parents” and “a high-risk mechanism of injury” may be unreliable in infants with abusive head trauma.
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