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
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
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
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
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
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
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,
Read More