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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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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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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