Core Journal Reviews

Filed Under: Tags: , November 17th, 2016 Leave a Comment

Non-Invasive End Tidal CO2 in Intentionally Poisoned Patients

Morbidity and mortality of the self-poisoned patient is often related to respiratory complications resulting from the ingested drugs.  As a result, these patients may require intensive care and monitoring.  The ability to predict the clinical course of a patient would be helpful to potentially prevent subsequent complications.

Currently, there does not exist a  clinical measurement that has been shown to be helpful in outcome prediction in the self-poisoned patient.
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Filed Under: Tags: , November 10th, 2016 Leave a Comment

Cherry Picking Patients in the ED

Triage and prioritizing patient care is an important skill that Emergency Medicine physicians must develop to become efficient and effective providers.  Previous studies have demonstrated statistically significant delays in door to provider time due to race and volume in the ED (Okunseri 2013, Sonnenfeld 2012).  No previous study has investigated variances in door to provider time based on chief complaint. 
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Vasopressin, Epinephrine and Steroids (VSE) in Cardiac Arrest

Cardiac arrest remains associated with very high morbidity and mortality, and neurologically meaningful recovery (the most important goal of cardiac arrest care) is a regrettably infrequent outcome despite the best efforts of providers. Resuscitative efforts in cardiac arrest patients typically center around ACLS algorithms and attempts to find and correct reversible causes of clinical decompensation,
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Filed Under: Tags: , , October 27th, 2016 One Comment

Normalization of Vital Signs Does Not Reduce the Probability of PE

In patients with symptoms of pulmonary embolism (PE), we often turn to vital signs, including heart rate, respiratory rate and pulse oximetry, as part of our initial impression of the patient.  Before even considering further testing, such as d-dimer or CTPA, we look first at the vital signs to form our gestalt impression of the patient. 
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The Impact of Rudeness of Medical Team Performance

Iatrogenesis is an adverse patient condition directly resulting from medical treatment or error, occurring in nearly 4% of hospitalizations with 50% being preventable and 14% resulting in death (Berwick 1999, Brennan 2000).  What is even more concerning is that studies have suggested that this rate is higher in pediatric patients. Research has focused primarily on patient-related factors like age and weight,
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Filed Under: Tags: October 13th, 2016 Leave a Comment

More Than Just Meds – Social Needs of ED Patients

In our current healthcare system, Emergency Departments (ED) have become central to the health “safety net” of the nation.  Although Emergency Medicine is designed to provide acute medical care, its position within the healthcare system has created a dependence on EDs to address the complex social as well as medical situations with which patients present. 
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Filed Under: Tags: , , , October 6th, 2016 Leave a Comment

Relevance of Discharge Glucose Levels and Adverse Events

Although many patients visit Emergency Departments (EDs) for hyperglycemia, there is no consensus on optimal care prior to discharge. Most of these patients present with moderate elevations of serum glucose without severe manifestations (i.e. diabetic ketoacidosis, hyperosmolar hyperglycemic state). The risk of discharging patients with an elevated glucose level is unknown.
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Filed Under: Tags: , , , September 29th, 2016 Leave a Comment

Validation of the Modified Sgarbossa Criteria

It has been recognized since the 1940s that the presence of a Left Bundle Branch Block (LBBB) obscures the EKG diagnosis of myocardial infarction (MI). The publication of the Sgarbossa criteria in 1996 aided in clarifying this issue.

Sgarbossa Criteria (Sgarbossa 1996)

However, these criteria are not perfect. The original,
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