recent articles

In the Literature

Imaging in Frequent ED Users with Alcohol Use Disorders

There is a growing effort to better characterize patient populations with extremely high ED usage, with the goal of developing effective interventions and delivering better care. A particularly challenging subset within this group includes those with alcohol use disorders, who we see frequently, but are not well defined in the literature. With that in mind, I took part in a chart review (in press, made available online today @ JEM) looking at our institution's most frequent users over a period of 3 years, with specific concern for frequency of imaging studies and the associated findings. Bottom line - these patients are scanned all the time, and for good reason. All the more reason to recalibrate how we approach the paradox of treating a chronic disease like alcoholism in patients seen almost exclusively in an ED setting.

happenings

EMCrit/Sinai ED Critical Care Conference Recap

"With a little help from my friends..."
Today was the 9th annual ED critical care conference hosted at the Mount Sinai Icahn School of Medicine and the emDocs crew was in attendance. This conference is described as "the largest free Emergency Critical Care conference in the country," and speakers this year included giants like Rich Levitan, Haney Mallemat, and Scott Weingart. And the rumors about the cage match between Andy Jagoda and Anand Swaminathan were true.

practice updates

Intubating the Critically Ill Patient

"Two independent variables associated with post-ETI arrest: Pre-induction shock index and weight"

Intubating beyond the ABCs: Learn how to support your crashing patient while providing definitive airway management. Zach Radwine, MD covers identification of patients at risk for hypotension, dealing with hemodynamic instability, and how to address the numerous complications that may arise.

practice updates

Push-Dose Pressors

"Despite the multitude of studies, the excellent results, and the commonplace use by anesthesiologists for decades, the use of push-dose pressors has not yet made its way into standard emergency medicine practice"
For a patient in shock, or with anticipated instability during procedural sedation, push-dose pressors can be a lifesaver. Brendon Browning, DO covers administration of pressors under circumstances in which central lines and infusions either aren't available or aren't needed.

Peds EM Morsels

Rapid MRI for VP Shunt Evaluation

"Patients with hydrocephalus will have nearly 4 scans per year during childhood"

For evaluation of VP shunts in children, the cost and study duration a rapid MRI is closer to CT than you might think (and without the ionizing radiation!). Best of all, the evidence comes from studies performed with populations chiefly less than 5 years of age. In this article, Sean M. Fox, MD makes a strong argument about why rapid MRIs should be a part of your institution's protocol.