Brit Long

Organ transplantation is becoming increasingly common. These patients present a challenge to emergency physicians as they are on immunosuppressive medications and have anatomic and physiologic variations. Transplant patients are at risk for a number of complications including infection, medication effects, rejection and complications specific to the transplanted organ.

FOAMed has revolutionized medical education. This is the second part of a multipart series evaluating FOAMed resources for learners of all levels. Today’s post covers ultrasound, an essential tool in emergency medicine.

Free Open Access Medical Education has produced a revolution in EM education, with hundreds of blogs and podcasts. FOAMed allows providers to rapidly stay abreast of the literature, while improving patient care. This is the beginning of a series evaluating FOAMed resources for learners, depending on subject matter. Today’s post will evaluate electrocardiogram (ECG) resources.

The management of unstable ventricular tachycardia and pulseless tachycardia is simple – electric cardioversion. However, there are several management options for stable tachycardia. This article reviews these options as well as the most recent updates.

Ophthalmologic medications carry a wide variety of indications and effects. The caps of the bottles have thus been color-coded to reflect these differences. Read this primer for a thorough run-down of all these medications and their uses.

Pulmonary embolism (PE) is classically a life-threatening diagnosis, often considered in the work-up of patients with chest pain or dyspnea. Initial mortality rates of missed, untreated PE has been quoted as high as 26%, based on a 1960 study. This disease is common, with 400,000 patients affected with nonfatal PE and another 200,000 patients in the U.S. dying each year from this disease. PE is the third most common cause of death in cardiovascular disease after myocardial infarction and stroke.

Trauma patients require systematic resuscitation and definitive treatment. However, there are sometimes underlying reasons for the injury, such as syncope prior to the injury or even an underlying infection that made him or her prone to injury. Not all trauma patients will be unstable from their injury and they may have underlying comorbidities that need to be uncovered and treated. This article reviews some basic steps that can be taken to evaluate for underlying infection in trauma patients.

Struggling to decide if your patient requires a RBC transfusion? Read on: we’ll review the most recent studies and evidence-based guidelines to aid in your clinical decision-making.

Clinical decision rules (CDR) can improve decision-making in specific situations in the ED, potentially decreasing further testing and improving disposition times. This part of the CDR series will look in detail at a current clinically significant CDR and pathway – The HEART pathway.

There are often multiple roadblocks to incorporating a CDR into clinical practice. These can be broken into the 1) individual provider and 2) the institution.

1. Emergency physicians are a rare breed, and many of us do not appreciate suggestions on how to practice. Individual providers vary in many regards: training, knowledge, experience, and gestalt. Workups and treatments can significantly differ among providers. With CDRs, physicians may be hesitant to apply these rules to their own practice. They may feel the rules are too complex, too difficult to remember, or detract valuable time from patient care. Providers often feel that gestalt or experience is better than rules.

2. Institutions may have habits or a culture for particular conditions that may make it difficult to apply a rule. Tradition or consultant availability may color the use of CDRs. Unfortunately, the medico-legal environment or funding can also play a large role in the use, or lack thereof, for CDRs.