LVAD Complications: A review

This is a nice little review by Dr. Long in Dallas entitled: B. Long, J. Robertson, A. Koyfman, et al., Left ventricular assist devices and their complications: A review for emergency clinicians, American Journal of Emergency Medicine, https://doi.org/10.1016/j.ajem.2019.04.050 INTRODUCTION: A ventricular assist device (VAD) can be placed into the right, left, or both ventricles thus […]

ST segment elevation in aVR is probably NOT a STEMI…BUT, damn, are they sick!

There I said it. Well Ok I’ve been saying it for a while. But say this to a room full of doctors and you might be ostracized! Well there has been mounting evidence that would argue aVR ST elevation is not an acute STEMI/ STEMI equivalent for a while now. I think this article clinches […]

Emergency Contraception in the ED and BMI?

We in the ED may sometimes be asked advice on emergency contraception (EC). The most popular one available is levonorgestrel. The message from this quick hit article is pretty simple and serves as a simple reminder: Clinicians should counsel women with BMI ≥ 26 kg/m2 on the potential limitations of oral levonorgestrelfor EC and offer […]

Fill the Tank or Rev’ the Engine… WHOA, PUMP the BRAKES: Early fixed dose norepi for septic shock?

We all know hypotension is bad. But should we fill with fluids or rev up the heart with pressors. This begs the question does early norepi help prevent hypotension and mortality? Today’s quick hit article: Permpikul C, et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) : A Randomized Trial. Am J Respir Crit Care Med. 2019 Feb 1. doi: 10.1164/rccm.201806-1034OC. PMID 30704260. […]

Lactate for Safely Screening Sepsis?

Fernando et. al. HELPFUL ONLY WHEN ELEVATED: INITIAL SERUM LACTATE IN STABLE EMERGENCY DEPARTMENT PATIENTS WITH SEPSIS IS SPECIFIC, BUT NOT SENSITIVE FOR FUTURE DETERIORATION Journal of Emergency Medicine, Vol. 54, No. 6, pp. 766–773. https://doi.org/10.1016/j.jemermed.2018.01.040 BOTTOM LINE: A lactate >4 in this prospective observational cohort study of almost 1000 patients with the “CMS” definition […]

To B (VM) or Not to B (VM) THAT is the question!

Source: Casey et. al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. NEJM. February 18, 2019DOI: 10.1056/NEJMoa1812405 Whether ‘tis noble in the mind to suffer the slings and arrows of aspiration or by bagging end them? This is a great methodological (and probably landmark) trial by the impressive authors at Vanderbuilt et al. They have been […]

Antibiotic StewardSHIP…Moveover Titanic…there’s a new failure in town.

Tamma, et al. Rethinking How Antibiotics Are Prescribed: Incorporating the 4 Moments of Antibiotic Decision Making Into Clinical Practice. JAMA. 2018 Dec 27. doi: 10.1001/jama.2018.19509. [Epub ahead of print] BOTTOM LINE: Providers should be asking themselves: “What is the likelihood my patient has an infection and that it requires antibiotic therapy?” Those who know […]

Macrolide Resistance: Is Resistance Futile?

There hasn’t been an update to the IDSA/ATS guidelines for CAP (community acquired pneumonia) since 2007 (I keep hearing they will be out soon). These guidelines recommend  a macrolide antibiotic as first-line therapy for previously healthy patients who have no risk factors for drug-resistant S. pneumonia (SPN) infection (strong recommendation) and a combination of a […]

SUP-ICU Trial: Pantoprazole in patients at risk for Gastrointestinal Bleeding

SUP-ICU Trial Kart, M. Pantoprazole in patients at risk for Gastrointestinal Bleeding in the ICU. N Engl J Med 2018;379:2199-208. Trial done in the UK. It was a multicenter, stratified, parallel group, placebo controlled blinded randomized trial. Included pts admitted to the ICU who were 18 yo or older and had at least one risk […]

Its beginning to look a lot like…Research: Parachutes, Pharma and Golf; Oh My!

Ahhh….December! While some people look forward to christmas music, jingle bells, Jack Frost and New Years, most of us (well maybe just me) see December as one of the most evidenced based times of the year! Yes every December the classic and so-very –British tongue in cheek version of the BMJ comes out to delight our […]