CT use in the evaluation of trauma patients has risen dramatically in recent years. “Pan-scan” (CT scan from head through pelvis) is used routinely in many trauma centers in spite of the American College of Surgeons inclusion of avoidance of routine whole body CT in trauma in it’s Choosing Wisely recommendations. Although prior studies have demonstrated increased identification of traumatic pathology with “pan-scanning” there has not been a concurrent demonstration of decreased morbidity or mortality.
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Dabigatran Site of Action (www.medscape.com)
The burdens associated with the use of traditional anticoagulants such as subcutaneous heparins and oral vitamin K antagonists (VKAs) have spurred the popularity of non-vitamin K oral anticoagulants (NOACs) for stroke prevention in patients with nonvalvular atrial fibrillation and for the prevention and treatment of venous thromboembolism.
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The harmful effects of opioid dependence are well known to ED providers and include overdose, high risk behaviors, and psychosocial instability. Patients with opioid dependence represent a significant proportion of ED visits annually, whether for overdose, addiction/withdrawal treatment, or general medical and psychiatric care. Previous studies have shown that buprenorphine/naloxone, a partial opioid agonist + antagonist,
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Acute, non-traumatic low back pain (LBP) is a common chief complaint and has been estimated to lead to more than 2.7 million ED visits annually nationwide. It affects a broad range of individuals and can be painful and debilitating long after an initial ED visit. Often times in clinical practice, evidence based decisions on medical management of acute lower back pain seem to be thrown out the window;
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Resuscitative thoracotomy (RT) performed in the Emergency Department (ED) is a potentially life-saving procedure in patients with traumatic cardiac arrest. However, the procedure does have the potential to harm providers (i.e. fluid exposure). Therefore, it is important to weight two different perspectives: the patient is dead and will remain so if an RT is not performed so why not try it as a last ditch effort and that RT is low yield so why expend resources and create a potential risk of harm to providers.
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Fingertip amputations are common. Treatment options range from healing by secondary intention to flap coverage or replantation. Selection of the appropriate treatment modality depends on the nature of the injury, the physical demands of the patient, and the patient’s co-morbidities. Prophylactic antibiotic use in patients with fingertip amputations is controversial. The routine use of prophylactic antibiotics is universally recommended on grossly contaminated wounds,
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This review was cross-posted on REBEL EM.
Acetaminophen (paracetamol) is commonly used to lower the temperature of patients with fever suspected to be cause d by an infection in both homes across the world and the hospital. There are, however, opposing theories to the utility of decreasing fever in these situations. One side argues that fever places “additional physiological stress on patients,” who are already ill (Young 2015).
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