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.
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Angiotensin Converting Enzyme Inhibitors (ACE-I) are prescribed to millions of patients in the US. Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department. Though this disorder is routinely treated with medications for anaphylaxis (i.e. epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will fail.
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In the US, vast differences in pricing exist for the same medical services across the country, with no correlation shown between price and quality (Sinaiko 2017). Previous studies on price transparency in medicine have shown that many patients would like to know “the price of medical services in advance and are willing to look for ‘better-value care’” (Sinaiko 2017).
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Cellulitis is a common emergency department (ED) presentation. Despite the fact that diagnosis remains relatively straight forward, complexity remains in management in terms of the causative agent and appropriate antibiotic regimen. Though beta-hemolytic Streptococci are the most common causative agents there is increasing prevalence of community acquired methicillin-resistant Staphylococcus aureus (MRSA). Cephalexin has long been used to treat uncomplicated cellulitis because of it’s activity against streptococci and methicillin-sensitive S.
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In 2002, the New England Journal of Medicine published two studies that changed the management of post-cardiac arrest patients by showing improved outcomes in patients treated with therapeutic hypothermia (32°C-34°C) for at least 24 hours. (Bernard 2002, Hypothermia 2002) The landscape changed again in 2013 with the publication of the Targeted Temperature Management (TTM) trial in the New England Journal,
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There is scant evidence published on the long-term outcomes of systemic thrombolysis in acute submassive PE. Many advocate for the use of systemic thrombolysis to reduce morbidity (complications from chronic pulmonary hypertension) and mortality. The PEITHO trial compared systemic thrombolysis (with tenecteplase + heparin) vs no systemic thrombolysis (placebo + heparin) in just over 1000 patients with confirmed PE,
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Sepsis remains a condition with a high mortality rate, and prompt recognition of the condition is essential. The presence and severity of fever raises suspicion for infection and is frequently a significant factor in medical decision making in the Emergency Department (ED). However, many septic patients are not febrile, which can impede prompt identification of critically ill patients.
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While early recognition and treatment of sepsis has improved outcomes, mortality rates continue to be high. In low income countries, septic patients suffer mortality rates as high as 60%. Sepsis has been associated with vitamin c deficiency, with lower levels of vitamin c being associated with higher mortality rates. Prior studies targeting pathophysiological effects of sepsis have failed.
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