recent articles

practice updates

R.E.B.E.L. EM – Is Too Much Supplemental O2 Harmful in COPD Exacerbations?

Does hyperoxia suppress a COPD patient’s respiratory drive? Does it cause V/Q mismatch? Does it change the chemistry of the patient’s blood through the Haldane effect? It’s enough to make you want to give up and page respiratory therapy. Well lucky for you we sifted through the primary literature to bring you the myths and facts, and the short answer is… it’s complicated.

practice updates

Acute Chest Syndrome

Often, the dreaded complications that we are taught to look for don’t present to us in the Emergency Department, but develop and evolve during the hospitalization that began with the patient seeing us in the ED. Our skill can help the child in distress, but our vigilance can detect the evolving Acute Chest Syndrome and perhaps even prevent it. Thanks to Sean M. Fox, MD (@PedEMMorsels) for this gem with significant clinical relevance.

practice updates

Ventilator Management in COPD

Editor's note: This post was listed in the #FOAMED Review (17th Ed.) from EM Curious. It ALSO appeared in LITFL Review 154's "Best of #FOAMcc Critical Care" section.

Its 7:01am.  Your shift in your department’s high acuity area is just beginning, and you are waiting to receive sign out.  There hasn’t even been time to get your first sip of coffee.  Just as you are lifting your cup to your lips, the charge nurse grabs you and says, “Doctor, I need you!  This patient isn’t looking so good!” [...]

practice updates

Outpatient PE treatment

Editor's note: This post was listed in the LITFL Review 153's "Best of #FOAMed" category. Venous thromboembolism (VTE) (deep vein thrombosis or pulmonary embolism) has an incidence of roughly 1 in 1,000 with an incidence of PE with or without DVT of 2.3 per 10,000. One major factor to consider is that VTE is much more common in the elderly and has a mortality highly associated with co-morbidities such as cancer and underlying cardiovascular disease. In the distant past any diagnosis of DVT and/or PE would result in admission for heparin bridging to oral anticoagulation therapy. This was largely due to a fear that outpatient management would lead to an increase in fatal embolic or major bleeding events. However, there is a great amount of literature that has established the safety of outpatient management of “low-risk” DVT; outpatient treatment has become standard of care for these patients. “Low-risk” patients were those with no prior VTE, no PE, no prior heparin use, and no confounding co-morbidities (cancer, infection, stroke, etc). So what about PE? If outpatient management is standard of care for a select group of DVT patients, then can we treat PE as an outpatient? [...]

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.