recent articles

practice updates

Supraglottic Airway Review

"The LMA also serves as a well documented rescue device for 'can’t intubate, can’t ventilate' situations"
Daniel Ostermayer, MD compares the various extraglottic airway devices available for adult and pediatric patients.

practice updates

D-Dimer in Aortic Dissection Workup

"Higher d-dimer levels correlate with more segments of the aorta involved, with false lumen type dissections, and with higher mortality rates"

D-dimer has great sensitivity for aortic dissection, but its true clinical utility in the workup of this high-risk diagnosis remains undefined. Tim Schaefer, MD reviews diagnosis and management, as well as the recent literature on the role of the d-dimer.

From @EMSwami

Epinephrine in Cardiac Arrest

"It’s time to re-examine this recommendation"
Epinephrine in cardiac arrest: helpful for ROSC, but maybe not so much for good neurological outcomes. Anand Swaminathan, MD MPH takes a thought-provoking look at the historical evidence behind this practice, as well as at newer evidence that calls its benefit into question.

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.