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happenings

Pregnant and Sick: Haney Mallemat (AllNYCEM6)

"Everything that can go wrong with these patients will"
Our second writeup from the 6th All NYC EM Conference is of Dr. Haney Mallemat's lecture on the critically ill and expecting patient. He covers the important underlying physiologic principles, changes you should (or shouldn't) make to your usual approach with a critical patient, and pitfalls you need to be aware of. The information he gave was great - detailed yet still able to be abstracted into an easy mnemonic. We hope you enjoy it (we sure did!).

happenings

PE and Evaluation of Risk: Pik Mukherji (AllNYCEM6)

"More a story of over-testing than risk"
The 6th All NYC EM Conference was held on March 12, 2014 at the NY Academy of Medicine. There were some fantastic talks, with highlights tweeted throughout on #AllNYCEM6. A contingent of the emDocs team was also there, taking lots of notes so we can now present to you a more detailed summary of Dr. Pik Mukherji's (@ercowboy) excellent lecture on pulmonary embolism and the current state of testing and treatment in the ED.

practice updates

PERC Rule: Application and Limitations

"Pleuritic chest pain [...] is not in a validated clinical decision rule despite having a higher OR for PE than hemoptysis and recent immobilization"
The PERC rule can be a wonderful thing, but requires judicious use. Jason West, MD reviews the literature, discussing applicability and limitations of the PERC rule, so you'll know when to feel confident foregoing the D-dimer and when to be more cautious.

practice updates

Synthetic Cannabinoids

"There have been a growing number of cases associated with life-threatening neurotoxic effects and cardiotoxic effects"
Cynthia Santos, MD gives a nice overview of the increasingly popular synthetic cannabinoids, including the range of clinical presentations, management, and the bottom line for your practice in the ED.

practice updates

Ketamine for Analgesia in the ED

"Ketamine provides excellent analgesia with no or minimal effects on perception or emotion"
We are very excited to bring you a post from Reuben Strayer, MD (@emupdates) on ketamine as an alternative to opiates for pain relief in the ED. The discussion highlights indications for use, dosing recommendations, and how to avoid potentiating the medication's psychiatric effects.

practice updates

Update: Analgesia and Sedation in the Intubated ED Patient

"Targeting light sedation within the first twelve hours of intubation decreases morbidity and mortality"
Taking a thoughtful approach toward keeping your intubated patient comfortable is not just the humane thing to do - it can make a big difference in their ultimate outcome. Rachel Shard, MD discusses strategies for pain relief and sedation in these patients, including prioritization of analgesia and the pros/cons of propofol, benzos, and dexmedetomidine.