A particularly complicated case and tricky diagnosis, along with the need-to-know information for all emergency physicians

The transplant patient is always sicker than they appear. It is important to be aggressive in these patients since they are severely immunocompromised which not only puts them at greater risk of infection but also blunts their normal signs to infection. Always contact the transplant team to help with management as many centers have specific protocols for treatment of rejection and infection. Often it is very difficult to differentiate between rejection and infection. In these cases, treat on the side of infection as it would be the greatest immediate threat to life in the patient. [...]

The HEART score is an invaluable adjunct to emergency physicians when deciding which chest pain patients are appropriate for early discharge.

There have been a number of new publications reviewing our approach to managing sepsis. Both the ProCESS Trial and ARISE trial published in 2014 editions of the New England Journal question whether invasive procedures and rigid protocols are required to have positive patient outcomes. Other studies included in this power review examine the importance of early antibiotic therapy, effects of different mean arterial pressure parameters, and impact of chloride heavy versus chloride restricted solutions.

Update: This AMA will be happening Friday, December 12th from Noon-1:30pm EST.

Locate the best site for needle insertion, demonstrate the appropriate angle of insertion, and measure the distance to reach the subarachnoid space.

The things you need to know about MERS...

For your Friday afternoon, here's another batch of excellent write-ups from the EM interns at UT Southwestern. Our ongoing intern report series is the product of first-year residents exploring clinical questions they have found to be particularly intriguing, with an intended audience of med students & junior residents. Enjoy! [Note: These are PDF files.]

• CHF Exacerbation by Meaghan Dehning, MD
• Use of Ultrasound in Endotracheal Intubation by Andrew Fredericks, MD
• Ventilator Strategy for an Acute COPD Exacerbation by Andrew Fredericks, MD
• Wernicke's Encephalopathy by Richard Moleno, DO; edited by Larissa Velez, MD
• Serotonin Syndrome by Andrew Fredericks, MD; edited by Larissa Velez, MD
• Steroids for Sciatica by Christina Smith, MD
• Post-Partum Fever by Meaghan Dehning, MD
• Pressor Choice In Shock by Chris Chase, MD
• Procedural Sedation in the ED by Chris Chase, MD
• RSI Pharmocology for the EM Physician by Richard B. Moleno, DO
• Management of Traumatic Subungual Hematoma by Lindsay Schroeder, MD
• Leukocytosis in the Immunocompromised by John R. Corker, MD
• H&P for Ovarian Torsion by Gray Millsap, MD
• Pericarditis by Ashley Phipps, MD
• Estrogen for Uterine Bleeding by John R. Corker, MD
• Treatment of Intractable Hiccups by Ashley Phipps, MD
• Central Venous Access Site Comparisonby Kevan Beth Meadors, MD
• COPD Exacerbations and Managementby Stace Breland, D.O.
• Epistaxis by by Gray Millsap, MD
• Energy Drink Toxicityby Kevan Beth Meadors, MD
• Delayed Neuro Injury Following Electrocution: Two Case Reports by Brandon Morshedi, MD
• Compartment Syndrome by Alex Cohen, MD
• Appy In Pregnancy by Christina Smith, MD
• Benzo Resistant Alcohol Withdrawal Seizures by William Fox, MD, edited by Larissa Velez, MD
• Benzodiazepines in Alcohol Withdrawal Syndrome: Preventing “Kindling” by William Fox, MD, edited by Larissa Velez, MD
• APAP Overdose by Alex Cohen, MD