recent articles

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.

ultrasound

Shoulder Ultrasound: Intra-Articular Injection and Reduction

"One systematic review found intra-articular injections to be as safe and effective as procedural sedation for bedside shoulder reductions"
Last month Tyler Dschaak, MD told us about using ultrasound to diagnose a septic hip. Today's post is on the utility of ultrasound in the diagnosis and management of shoulder dislocations.

Peds EM Morsels

Options to Intravenous Fluids

IO Placement: "Should be done without hesitation in a child who lacks easily obtainable IV access and signs of poor perfusion"
Placing an IV in a sick pediatric patient can be a real challenge. Fortunately, there are options! Thanks to Sean M. Fox, MD (@PedEMMorsels) for this gem with significant clinical relevance.

From @EMSwami

IV Contrast Myths

"Premedication with corticosteroids has never been shown to reduce the risk of moderate or severe adverse drug reactions"
We're thrilled to present another game-changing writeup from Anand Swaminathan, MD MPH (@EMSwami), this time on the conundrums of shellfish allergies and utility of premedication in patients receiving IV contrast.

practice updates

Electronic Cigarettes and Liquid Nicotine Poisoning

"The delayed phase consists of cns and respiratory depression, dyspnea, bradycardia, hypotension, shock, mydriasis, weakness, muscle paralysis, and coma"
We are very pleased to present you with this overview on the potential dangers of electronic cigarettes and liquid nicotine from the toxicologists at UT Southwestern.

ultrasound

Hip Ultrasound and Arthrocentesis

"Emergency physicians with ultrasound training have been shown to be capable of visualizing effusions of the hip with a sensitivity between 80-85% and specificity between 98-100%"
Tyler Dschaak, MD provides a brief overview of hip ultrasound in the ED, including diagnosis of effusions and arthrocentesis.

practice updates

Asymptomatic Hypertension

"We should only intervene under very specific circumstances"
Asymptomatic hypertension in the ED: Should we be screening for end-organ damage? Should we intervene? Joshua Bucher, MD covers the 2013 ACEP Clinical Policy addressing these common questions.

From @EMSwami

Myths in DKA Management

"The bolus insulin group had longer lengths of stay and a 6-fold increase in hypoglycemic episodes"

Anand Swaminathan, MD MPH (@EMSwami) addresses urban legends in DKA management, including VBGs vs ABGs, when to replete potassium, bicarb administration, and insulin boluses.