Core Journal Reviews

Filed Under: Tags: , , , , March 31st, 2016 Leave a Comment

Topical Anesthetics in Corneal Abrasions

Corneal abrasions account for approximately 10% of eye-related visits to the Emergency Department (ED). The cornea is a highly innervated structure and, thus, remarkably sensitive, making this condition a notoriously painful one. We have all witnessed the almost magical analgesia achieved with application of topical anesthetics when evaluating these patients. Unfortunately, we limit the use of this effective pain management modality to the ED because of the seemingly prohibitive dangers of prolonged use of these agents.
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Filed Under: Tags: , , , , March 24th, 2016 2 Comments

Continous vs Interrupted Compressions in OHCA

In cardiopulmonary resuscitation (CPR), chest compressions are frequently interrupted to provide rescue breathing. It has been documented in several pig models that these pauses are associated with a decrease in coronary perfusion pressure. Furthermore, it may take several minutes of chest compressions to restore perfusion pressures to adequate values. Other studies have found interruptions to be associated with decreased survival in animals with cardiac arrest.
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Filed Under: Tags: , March 17th, 2016 Leave a Comment

Cyanoacrylate to Secure Peripheral IVs

Peripheral venous cannulation is the most frequently performed procedure in the Emergency Department (ED). The vast majority of patients admitted to the hospital will leave the ED with an intravenous catheter (IV). While these devices typically have a “life-span” of 72 hours from placement, they often fail prematurely as a result of infection, phlebitis, occlusion or dislodgement.
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Filed Under: Tags: , , , March 10th, 2016 Leave a Comment

Predictors of Failed Outpatient Cellulitis Treatment

Despite several expert panel recommendations and cellulitis treatment guidelines, there are currently no clinical decision rules to assist clinicians in decideding which Emergency Department (ED) patients should be treated with oral antibiotics and which patients require IV therapy at first presentation of cellulitis amenable to outpatient treatment.

Cellulitis is an acute or subacute infection of the dermis and subcutaneous tissue of presumed bacterial etiology charactrerized by warmth,
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Filed Under: Tags: , , , , March 3rd, 2016 Leave a Comment

Spectrophotometry or Visual Inspection for Xanthochromia

Although non-contrast head CT (NCHCT) has near perfect sensitivity (98-100%) in detecting aneurysmal subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset, sensitivity declines after 6 hours. As a result of declining sensitivity, lumbar puncture (LP) continues to be part of the workup in suspected SAH. An LP gives providers the ability to perform CSF analysis for red blood cells and detect xanthochromia by visual inspection or spectrophotometry.
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Filed Under: Tags: , February 25th, 2016 Leave a Comment

Risks of Aggressive Reduction of Door-to-Balloon Time

The advent of percutaneous coronary intervention (PCI) led to a decrease in morbidity and in-hospital mortality for patients presenting with ST-elevation myocardial infarctions (STEMI). In 1999 the American College of Cardiology and American Heart Association updated their guidelines with the benchmark door-to-balloon time (DTB) to be less than 90 minutes. It has since been adopted as a measure of quality with many hospitals attempting to achieve faster times with the thought that shorter times will improve clinical outcomes.
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Filed Under: Tags: , , , February 18th, 2016 Leave a Comment

Identification of High-Risk ACS Patients Using POC Echo

Current American Heart Association (AHA) recommendations suggest that high-risk patients with unstable angina or NSTEMI should undergo early invasive intervention. Risk stratifying these patients generally relies on serial EKGs and troponins, which can delay findings and subsequent intervention as these tests require time and do not have optimal sensitivity or specificity.

Though not a traditional part of the Emergency Department (ED) workup,
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Filed Under: Tags: , February 11th, 2016 One Comment

Isopropyl Alcohol in the Treatment of Nausea

Nausea is a common complaint seen in the Emergency Department (ED). Although there are a number of agents available for treatment, the efficacy and safety of these drugs have recently come into question. Metoclopramide is a commonly used antiemetic agent but it carries significant side effects including akathesia and tardive dyskinesia. Ondansetron is another central acting drug that has been shown to be effective in nausea prophylaxis in patients receiving chemotherapy but has a black box warning due to its effect of prolonging the QT interval.
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