Core Journal Reviews

Wells’ Score + D-dimer to Rule Out PE

In the US, pulmonary embolism (PE) kills 100,000 people each year and over 360,000 new cases of PE are diagnosed each year (Horlander 2003). Currently, the gold standard for diagnosing PE is the computed tomographic pulmonary angiography (CTPA). Patients with PE present with varying symptoms, from anxiety and tachycardia, to shortness of breath and syncope.
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Filed Under: Tags: , , September 4th, 2018 Leave a Comment

STONE Study – Efficacy of Tamsulosin in Ureteral Colic

Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously (i.e. without urologic intervention). For over a decade, calcium channel blockers (i.e. nifedipine) and,
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Filed Under: Tags: , August 30th, 2018 Leave a Comment

Comparison of IM Midazolam, Olanzapine, Ziprasidone and Haloperidol for Sedation

Emergency providers frequently care for agitated patients ranging from restlessness to verbally and physically aggressive. Agitation is a symptom, not a diagnosis and these patients require careful evaluation to rule in or out serious medical conditions. Unfortunately, the agitation itself often obstructs this evaluation and places the patient, other patients and staff at risk. While verbal de-escalation can be effective in select cases,
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Cervical Spine Evaluation and Clearance in the Intoxicated Patient

Alcohol and drug intoxication is common in trauma patients and a significant proportion of cervical spine (c-spine) injuries occur in patients with intoxication. A standard approach to both intoxicated and sober patients with suspected c-spine injury in many trauma centers includes the placement of a rigid cervical collar for spinal immobilization until the c-spine can be “cleared.”  Even after a negative CT,
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Filed Under: Tags: , , August 16th, 2018 Leave a Comment

MgSO4 in Pediatric Asthma – Meta-Analysis

Acute asthma exacerbations are a common presentation to pediatric emergency departments (EDs). Standard treatment with inhaled beta agonists and corticosteroids are often sufficient in mild asthma but can fall short in the treatment of moderate to severe exacerbations. Magnesium sulfate (MgSO4) has long been touted as an adjunct treatment due to its bronchodilatory properties (both in its intravenous (IV) and nebulized form).
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Procalcitonin Utility in Acute Respiratory Illnesses (ARI)

In patients with an acute respiratory illness (ARI), it is often difficult to determine whether a bacterial infection is the underlying etiology and whether antibiotics are warranted. Excess antibiotic use carries risk of bacterial resistance, medical costs, and adverse drug effects. However, underuse of antibiotics risks inadequate treatment and progression of disease. In the setting of a bacterial infection,
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Filed Under: Tags: , , , , August 2nd, 2018 Leave a Comment

Focused Echocardiographic Evaluation in Life Support and Peri-Resuscitation (FEEL Study)

Focused use of ultrasound in resuscitation of patients with shock and cardiac arrest has become increasingly embraced in both the emergency department (ED) as well as in the prehospital setting. Application of ultrasound, particularly of echocardiography, has the potential to identify treatable causes of shock and arrest, identify shockable rhythms and identify the presence of mechanical activity.
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Filed Under: Tags: , , July 26th, 2018 Leave a Comment

Esmolol in Refractory Ventricular Fibrillation

Refractory ventricular fibrillation (VF) is very difficult to manage. Up until recently, emergency providers were limited to defibrillation and delivery of high quality CPR as well as amiodarone administration. However, a couple of recent trials have given us food for thought about two possible additional treatments. The first treatment, dual sequential defibrillation has been investigated in retrospective case series and has shown potential for benefit.
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