recent articles

practice updates

NAC for Prevention of Contrast-Induced Nephropathy

"In patients with CIN risk factors, there is currently insufficient evidence to recommend routine NAC use"
Thanks to Artur Pawlowicz, MD and Matthew Ryan, MD, Ph.D. for this overview of the literature on the role (or lack thereof) of n-acetylcysteine in preventing contrast-induced nephropathy.

Ask Me Anything

Ask Me Anything: Reuben Strayer, MD

Thanks to Reuben Strayer for letting us ask him anything. He covered resident education, how to think like an ED physician, practice pearls including ketamine analgesia, chest tube insertion, awake intubation and much more. Follow him at @EMUpdates or check out his latest work on emupdates.com.

practice updates

Lipid Emulsion Therapy

"The lack of high-quality controlled human studies precludes ILE as a first-line agent for indications other than local anesthetic systemic toxicity"
Thanks to James Cao, MD for this excellent review of the literature on the use of ILE therapy in various toxicologic emergencies.

clinical cases

Mystery Bleed (M&M)

We're grateful to Mathew Miskimon, MD PhD for providing this morbidity and mortality (and improvement!) case from Janus General. Includes a nice discussion at the end on the systemic factors contributing to the outcome.

practice updates

Airway Subtleties in Critically Ill Patients

DKA: "Trying to intubate [...] using standard approaches can cause a period of apnea, which can kill your patient"
Cynthia Santos, MD with recs for your patients with salicylate toxicity, sepsis-induced ARDS, and DKA (ie, the ones who will likely require some modification to your usual airway algorithm). Crucial info here!

clinical cases

"Rule out SBO"

A diagnostic dilemma from the case files of Janus General. The presentation of this clinical zebra is provided by one of our esteemed editors, Adaira Landry, MD (@AllAroundDoc).

practice updates

Massive Vaginal Bleeding

"Packing may be the most effective hemostatic temporizing measure that can be performed in the ED"
Jessica Lopez, MD discusses the management of the non-pregnant patient with severe vaginal bleeding, including tamponade techniques and the utility of tranexamic acid.