Core Journal Reviews

Acute Kidney Injury After Computed Tomography: A Meta-analysis

Imaging is one of the most important diagnostic modalities that physicians utilize. In 2013 alone, over 70 million CT scans were performed. Contrast-enhanced imaging can aid in diagnosing certain pathology and improve image quality. There has historically been a concern for post-contrast acute kidney injury (AKI), which is generally considered an increase in creatinine or a decrease in glomerular filtration rate hours to days after contrast administration.
Read More

Hyperbaric oxygen for acute carbon monoxide poisoning

Carbon monoxide is one of the most common causes of fatal poisoning through either intentional or unintentional exposure and accounts for almost 50,000 emergency departments per year. (Sircar 2015, PMID: 26032660) It is an odorless, colorless gas that is produced from relatively common sources such as vehicle exhaust, propane fueled heaters, wood/coal burning stoves and gasoline powered generators.
Read More

Accuracy of the Age-Adjusted Quick SOFA Score in Children

The sepsis 3 guidelines recommended the use of the Sepsis Related Organ Failure Assessment (SOFA) score for early identification of sepsis in adults (Singer 2016, PMID: 26903338). An abbreviated version of SOFA (Quick SOFA or qSOFA) includes variables available at the bedside in the ED (systolic BP, respiratory rate and mental status). The 2017 pediatric surviving sepsis guidelines acknowledge that there is insufficient evidence to endorse a specific sepsis trigger tool and recommend that each institution develop their own recognition bundle (Amer College Critical Care 2017,
Read More

Filed Under: Tags: , , February 13th, 2019 Leave a Comment

Predicting Escalated Care in Infants With Bronchiolitis

Bronchiolitis is the most common lower respiratory tract infection and the most common cause of admission in infants. Approximately 10% will require some airway support. The ability to identify those at risk for escalation of care would allow for appropriate disposition decisions.
Read More

Filed Under: Tags: , , February 6th, 2019 Leave a Comment

Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries

Prior to this study, the preoperative approach to hypotensive patients with trauma included prompt intravenous infusion of isotonic fluids – the rationale being to sustain tissue perfusion and vital organ function while diagnostic and therapeutic procedures were underway. This was based on animal studies in the 1950s that demonstrated isotonic-fluid resuscitation was an essential component of therapy for severe hypotension due to hemorrhage.  
Read More

Filed Under: Tags: , September 18th, 2018 Leave a Comment

New Orleans Head CT Criteria

CT scans are frequently done after minor head injury to evaluate for intracranial hemorrhage. While CT scans are an excellent tool for diagnosing or ruling out this disorder, they are not without harms including radiation exposure, cost and department delays. Much of the time, CTs are negative, or find injuries for which no intervention is ever done and do not clinically affect the patient.
Read More

Filed Under: Tags: , , , , September 13th, 2018 Leave a Comment

Edoxaban in Cancer-Associated VTE

This post is cross-posted on REBEL EM

Venous thromboembolism (VTE) occurs frequently in patient with cancer. Treatment in this group entails a number of challenges including a higher rate of thrombosis recurrence and a higher risk of bleeding. Standard therapy at this time for both symptomatic and asymptomatic VTE is with low-molecular-weight heparin (LMWH) based on results from the CLOT trial (Lee 2003).
Read More

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.
Read More