Within the Emergency Department (ED), rapid identification and stabilization of critically ill patients with upper gastrointestinal bleeding (UGIB) is essential to patient survival. While there are some clinical prediction scores, ED physicians most often depend on clinical gestalt when risk stratifying and managing these patients. The most commonly used scores are the Glasgow-Blatchford score, AIMS65 and the Rockall score.
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In critically ill patients, fluid status is a balancing act. Too little fluid resuscitation can lead to end organ hypoperfusion, while too much fluid resuscitation can lead to pulmonary edema and respiratory compromise. In some situations, it is difficult to differentiate who will benefit from more fluids and who will be fluid unresponsive or even require fluid restriction.
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Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for complications including infection, thrombosis and mechanical dysfunction (pneumothorax, hematoma). The authors’ previous research led them to believe that these complications will differ according to the site of insertion.
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Supraventricular tachycardias (SVT) (excluding atrial fibrillation and atrial flutter) are common cardiac arrhythmias leading to presentation to the Emergency Department (ED). The Valsava maneuver is a recommended first-line method to cardiovert stable patients, but its reported efficacy is low (5-20%). Chemical cardioversion agents can have unpleasant side effects and require intravenous access. Increasing the success rate from the Valsava maneuver could lead to increased patient comfort and decreased resource utilization.
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Ketamine, a noncompetitive N-methyl-D-asparate and glutamate receptor antagonist, is a Phencyclidine-like dissociative agent that possesses potent analgesic, anxiolytic and amnestic properties. In the Emergency Department (ED), ketamine is commonly used for procedural sedation. Outside of the ED, subdissociative doses (0.3 mg/kg), have been successfully used as an adjunct to opiate refractory pain. Recent data has shown that subdissociative doses of ketamine may be comparable to morphine as a first-line agent in out-of-hospital settings.
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There are more than 450,000 Emergency Department presentations each year for children with blunt head trauma. 25% of visits for blunt head trauma are in children less than 24 months of age. Scalp hematomas in this age group maybe the only sign of traumatic brain injury (TBI). An astute clinician must clinically assess those with possible TBI,
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Abdominal pain is the most frequent presenting symptom in US emergency departments. The current standard care in the ED for upper abdominal pain involves ruling out severe causes (i.e. biliary disease, perforated viscous etc) and consideration of empiric gastric disease treatment with histamine blockers, antacids, or proton-pump inhibitors.
H. pylori is a bacterium that infects the stomach causing dyspepsia.
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Background: Patients with fluid refractory septic shock should be treated with vasoactive medications to improve perfusion. It has become widely accepted in recent years to use norepinephrine as the first-line vasopressor in adults with septic shock. In children, however, there is little research to guide our choice of agent. Dopamine has been used as the first-line agent in children though it has fallen out of favor in adults.
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