Massive hemorrhage is a major cause of early death in trauma patients. A vast majority of US trauma centers haves established Massive Transfusion Protocols (MTP) in order to facilitate early and aggressive balanced resuscitation. Though some institutions have created initiation policies to activate MTP, others rely on subjective clinical judgment based on initial vital signs for activation.
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Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 2008, Pallin 2005). Standard anterior epistaxis treatment consists of holding pressure, use of local vasoconstrictors, topical application of silver nitrate and placement of an anterior nasal pack. ED patients with epistaxis often fail conservative management and end up with anterior nasal packs which are uncomfortable.
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Sub-dissociative dose ketamine in the ED for treatment of pain is gaining recognition as an adjunct or alternative to opioid analgesics. Previous research from this group and others have demonstrated a role of low dose ketamine (0.1-0.3 mg/kg IV) as opioid sparing analgesic.The major issue with wider ketamine use is its adverse effects; the feeling of unreality,
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Since 2000, there have been over 500,000 opioid related overdose deaths in the US. (Burke 2016). Despite the epidemic of opioid deaths, these drugs continue to be used as first line agents for treatment of moderate to severe pain in Emergency Departments (EDs). While demonstration that ED use of an opiate causes future abuse and morbidity/mortality does not exist,
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Cardiac CT Angiography (CCTA) is a promising imaging technique that detects stenosis of the coronary arteries quickly and accurately. It can also detect other causes of chest pain when patients present to the emergency department (ED). Several studies have shown that patients with normal cardiac CCTA results are at low risk for adverse events (Oostema 2012).
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Acute Aortic Syndromes (AAS) are life threatening cardiovascular emergencies that are the bane of every emergency physician’s existence. They are diagnostic challenges due to the clinical presentation being highly non-specific. Computed tomography angiography (CTA), Transesophageal Echocardiography (TEE), and Magnetic Resonance Angiography (MRA) can help accurately diagnose AAS. CTA exposes patients to radiation and large doses of intravenous contrast,
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Thanks to Sergey Motov (@PainFreeED) for the expert review at the end of the post.
Acute, minor musculoskeletal injuries (i.e. non-fracture or dislocations) are frequently seen in the Emergency Department. Aside from ruling out a more severe injury, management often focuses on pain relief or mitigation of pain. Though many analgesic agents exist,
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Assessing fluid responsiveness is essential to guiding resuscitation of critically ill patients. Inferior vena cava (IVC) collapsibility measured by point of care ultrasound (POCUS) has been shown to accurately predict fluid responsiveness in mechanically ventilated patients. However, it’s utility in spontaneously breathing patients is less well established.
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