Acute lumbar radiculopathy is characterized by radiating buttock and leg pain in a lumbar nerve root distribution caused by herniation of the nucleus pulposus. It has a lifetime prevalance greater than 10% and can result in significant pain and disability. Epidural steroid injections and lumbar diskectomy are commonly performed, however oral steroids may provide the same anti-inflammatory benefits are less invasive,
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Over the past decade, endovascular therapy has been increasingly studied as a potential intervention for ischemic stroke. However, prior randomized trials of endovascular therapy in ischemic stroke failed to demonstrate clinical benefit. The prevailing thought from those studies was that patients most likely to benefit from endovascular therapy were not carefully selected. Specifically, patients did not receive rapid imaging to demonstrate a proximal occlusion and to rule out a large area of infarction prior to inclusion in those studies.
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Atrial fibrillation (AF) is a commonly encountered dysrhythmia in the Emergency Department (ED). Atrial flutter is less common but its management is very similar to that of AF. In patients with chronic AF or unknown time of onset and a rapid ventricular response (RVR), rate control and consideration and initiation of anticoagulation therapy are the standard ED approach.
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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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Injuries are a major cause of death worldwide. Millions of people die every year from traffic injuries. In fact, they are the 9th leading cause of death around the world. Additionally, another 1.5 million people die every year from interpersonal violence. Hemorrhage accounts for about 1/3 of all trauma deaths and as such, it should be our goal to find treatments to decrease death from hemorrhage.
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In patients who present to the Emergency Department (ED) with chest pain whose initial evaluation does not reveal acute myocardial infarction, the American Heart Association (AHA) recommends non-invasive testing to provoke ischemia or to detect coronary artery disease (CAD) before or within 72 hours of their discharge. Such testing is believed to identify patients who might benefit from more invasive therapy,
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Long-term oral beta-blocker use decreases mortality after myocardial infarction (MI). Our guidelines recommend initiation of this within 24 hours of acute MI. The benefit of IV beta-blockade is less clear. It is also unknown whether earlier beta blocker administration is better than delayed administration (within 24 hours).
-COMMIT Trial (2005): Early use of IV metoprolol in AMI decreases incidence of ventricular arryhthmias and reinfarctions,
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Abdominal CT is the most common initial imaging test ordered for suspected nephrolithiasis in the Emergency Department. This is largely due to its high sensitivity for the diagnosis of kidney stones and ability to assess for other high-risk diagnosis. However, CT scan results in exposure to ionizing radiation with related long-term cancer risk and a high rate of incidental findings.
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