Cardiac ultrasound is an established diagnostic modality in Emergency Medicine (EM). We use it to diagnose pericardial effusions (medical and traumatic), to discern the etiology of shock, to evaluate for congestive heart failure, and to guide treatment and prognosis in cardiac arrest. Nonetheless, the trans-thoracic approach (TTE) to cardiac ultrasound has its limitations: poor windows (in the trauma patient,
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Acute asthma presentations account for more than 2.1 million Emergency Department (ED) visits annually. In the US, 8.4% of the population is affected by the disease. Current guidelines from the National Heart, Lung, and Blood Institute recommend a minimum of 5 days of oral prednisone to treat moderate to severe asthma exacerbations (NHLBI Guidelines 2007).
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Sedation of the agitated and aggressive patient is a frequently encountered problem in the Emergency Department (ED). Whether the etiology of the agitation is intoxication, psychiatric, or organic, these patients require quick and efficient chemical sedation because they are both a danger to themselves and others in the ED. The majority of these patients are successfully sedated with antipsychotics or benzodiazepines (Downes 2009).
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Thanks to Salim Rezaie for providing pre-publication peer review for this post. This post is cross-posted on REBEL EM here.
Despite continued debate on the efficacy of alteplase (tPA), it currently remains one of the major interventions directed at patients presenting with acute ischemic stroke. The current standard dose of the drug is 0.9 mg/kg given over 1 hour.
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Every year in the United States there are an estimated 178.8 million episodes of acute gastroenteritis resulting in 473,832 hospitalizations. Most of the evidence surrounding oral rehydration centers around Oral Rehydration Therapy (ORT) studies in low-income countries where children suffer from more extensive gastrointestinal losses. Theoretically, electrolyte maintenance solutions are recommended in order to prevent increasing diarrheal losses through the osmotic diuresis that can occur with glucose-rich drinks like juice.
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Acute nontraumatic temporomandibular joint (TMJ) dislocations are uncommon presentations in the ED that occur after excessive mouth opening. Common circumstances include laughing, yawning and dental extraction. The most common TMJ dislocation is the anterior form and reduction can be labor intensive, protracted and typically requires procedural sedation.
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Ureteric colic is a common cause of severe pain. Anecdotally, many patients describe it as “the worst pain” they’ve experienced. In the Emergency Department (ED) pain is typically treated with either a non-steroidal anti-inflammatory drugs (NSAIDs) or an opiate or a combination of both. There are limited high-quality studies investigating whether one medication is superior to another or whether the route of medication administration makes a difference.
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Out-of-hospital cardiac arrest (OHCA) leads to over 300,000 deaths every year in North America. Many OHCA are due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are generally considered to have the best prognosis during cardiac arrest due to their responsiveness to defibrillation. However, attempts at defibrillation during cardiac arrest frequently result in non-sustained return of spontaneous circulation (ROSC),
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