The current ACLS guidelines give both procainamide and amiodarone a class II recommendation as chemical therapy for the treatment of patients with stable ventricular tachycardia. Despite the fact that one drug does not appear to have an advantage over the other based on available literature, amiodarone appears to be agent preferred by intensivists, cardiologists and Emergency Physicians alike.
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Total body CT scanning is increasingly being utilized as part of the initial survey of trauma patients in trauma centers. The belief is that initial total body scan provides a comprehensive evaluation of life threatening traumatic injuries, requires fewer trips to the CT scanner, and mitigates the necessity for other imaging modalities such as x-ray and ultrasound.
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When it comes to treating community acquired respiratory tract infections, macrolide antibiotics (azithromycin, clarithromycin and erythromycin) are a common choice of agent. In 2010, 57.4 million macrolide prescriptions were written in the U.S. with azithromycin being the most commonly prescribed individual antibiotic agent overall with ~51.5 million prescriptions (Hicks 2013)
With more and more patients being prescribed macrolide antibiotics,
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Prior to the creation of the Ottawa Ankle Decision Instrument, most patients presenting to the Emergency room with a complaint of acute ankle injury had ankle and or foot radiographs ordered to evaluate for fracture, even though the incidence of fracture among this population is relatively low (~ 15%). While ankle radiographs do not expose the patient to large amounts of radiation,
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Neck pain after blunt trauma is common but significant cervical spine injuries are not. An unrecognized cervical spine injury can be catastrophic as it can lead to serious neurologic disability or even death. As a result, we as clinicians are fairly liberal about performing imaging of the cervical spine after trauma. Prior to the creation of the NEXUS C-spine criteria and the Canadian C-spine criteria,
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Each year, 22 million people worldwide will experience a stroke. 50% of these are ischemic strokes. For years, there were no effective treatments for these patients. As a result, the burden of ischemic stroke was enormous. Patients often experience debilitating strokes requiring round-the-clock care. Acute ischemic strokes represent the leading cause of disability in our society and the third most common cause of death.
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Hemorrhagic stroke accounts for only 11-22% of all strokes but up to 50% of all stroke mortality. Additionally, there is significant disability associated with the disease in survivors. Much of our attention in the Emergency Department is guided towards preventing expansion of bleeding and secondary injury after the initial insult. Physiologically, controlling blood pressure has always appeared to be a reasonable goal as it may decrease hematoma expansion and thus mortality.
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Spontaneous, non-traumatic, intracerebral hemorrhagic strokes accounts for 11-22% of incidence strokes but 50% of all stroke deaths. There are about 2 million of these bleeds a year world-wide. Many patients with these types of bleeds and strokes in general will be on anti platelet agents like aspirin and clopidogrel. Anti-platelet therapy has been shown to increase incidence of and worsen outcome of spontaneous intracerebral hemorrhage.
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