recent articles

Peds EM Morsels

Delayed Diagnosis of Kawasaki Disease

"Set an alarm that gets your attention anytime someone presents with 'fever for 5 days'"
Sean M. Fox, MD (@PedEMMorsels) with some excellent tips on recognizing factors putting your pediatric patients at risk for delayed diagnosis of Kawasaki Disease, including the more challenging to diagnose "incomplete" form of the disease.

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.

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.