HYPONATREMIA 2.0

HYPONATREMIA PART I – TREATMENT RECOMMENDATIONS IN CASE OF HEMODYNAMIC INSTABILITY, THE NEED FOR RAPID FLUID RESUSCITATION OVERRIDES THE RISK OF AN OVERLY RAPID INCREASE IN SERUM SODIUM CONCENTRATION. TREATMENT GOALS: An increase by 4-6-mmol/L [Na] is sufficient to reverse most serious manifestations of acute hyponatremia. Increase [Na] no more than 10 mEq/L in 24 hour […]

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 […]

Aspirin for All Comer Chest Pain: Is it Naughty or Nice

Like it or not, we do a fair amount of primary care medicine in the emergency department. Therefore, we need to know some of the basics about primary care. One of the most fundamental concepts is the use of aspirin for prevention of MI either before the first one (primary) OR after (secondary) your patient […]

Quick Hit Article #12: Should you stay or Should you go for syncope

Anderson. Trends in Hospitalization, Readmission, and Diagnostic Testing of Patients Presenting to the Emergency Department With Syncope. Ann Emerg Med. 2018;72:523-532 Although this study doesn’t tell you who should be admitted it does nicely show the mortality, albeit inpatient only, and some interesting facts about admitted syncope patients. This was a retrospective epidemiology study of syncope-related […]

QUICK HIT #11: WHAT TIDAL VOLUME SHOULD BE STARTED IN PATIENTS WITHOUT ARDS

QUICK HIT ARTICLE Effect of a Low vs. Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS: A Randomized Clinical Trial. Writing Group for the PReVENT Investigators . Simonis. JAMA. 2018; 320(18):1872-1880 All right pop quiz, hotshot. Altered patient gets intubated in the ED. He’s almost to the ICU. The RT asks […]

QUICK HIT ARTICLE #10: How Low Should you Go? BP lowering without hypertensive emergency

Miller, JB. Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency. Am J Emerg Med. 2018 Aug 21. pii: S0735-6757(18)30690-9. doi: 10.1016/j.ajem.2018.08.052. There are not many studies of affects of blood pressure lowering on ED patients in the absence of end organ disease. This one is an interesting one and should […]

Stroke 2018 Update

In March New Stroke guidelines came out. Wow are they aggressive! tPA and endovascular therapy (EVT) for all… forget what the literature says! Well We NEED to know these so I’ve listed them here for reference. Sorry about the format. I’ll pretty it up soon! Stroke. 2018;49:e46–e99. DOI: 10.1161/STR.0000000000000158.) A primary goal of achieving door-to-needle (DTN) […]

ATLS 10th Edition 2018 Update

Since summer is closing and “Fall” is upon us I thought it would be a good time to “drop” some Trauma knowledge especially since “Crash (2)” is in the ATLS update. Here are the major changes in the 10th Edition of ATLS. Luckily ATLS is getting closer to the evidence and what many of us […]

Quick Hit Article #9: Thiamine for severe sepsis? Yes, No and Maybe?

Today’s quick hit article is probably the first in a long list of articles to come looking at Thiamine, vitamin C, or steroids for septic shock. Woolum. Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock. Critical Care Medicine 2018. Bottom Line: When compared in a chart review, patients with […]

Quick Hit Article #8: Say No To Flouro(Quinolone) in Pyelo

Quick Hit Article: Pyelonephritis treatment in the community emergency department: Cephalosporins vs. first-line agents. Vogler Am J Emerg Med. 2018 Aug 8. pii: S0735-6757(18)30652-1 The Bottom Line: In this retropsective chart review with moderate (not optimal) methods, patients placed on cephalosporins had significantly less treatment failure (0% vs 23%, p< 0.001) than when placed on either […]