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.
The Clinical Decision Rules Series (Part 3): Clinical Pathway Use Read More »
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.
Clinical Decision Rules Series Part 2: CDR Implementation Read More »
Clinical decision rules (CDRs) are everywhere in medicine today. They were developed to improve our decision-making capability. We are constantly under stress to improve throughput and diagnostic capabilities. CDRs are appealing in that they strive to take murky, unclear variables and change them into a structured tool or assessment. They can potentially take more factors into account than the typical physician at the bedside and give consistent results if applied appropriately.
The Clinical Decision Rules Series (Part 1) Read More »
Cerebral Venous Thrombosis (CVT) is a rare but emergent cause of headache. It is a difficult diagnosis to make due to a wide variety of symptoms. This article reviews the etiology, risk factors and symptoms of CVT. Imaging and treatment regimens are also discussed.
Cerebral Venous Thrombosis: Pearls and Pitfalls Read More »
Having difficulty deciding between procedural sedation agents in your pediatric patients? Read on: we provide a focused review of commonly utilized medications, with tips and tricks on how to cater your personal sedation practice to the clinical scenario.
Pediatric Procedural Sedation: What are your options? Read More »
How do you interpret quantitative capnography waveforms? We own the resuscitation of critically ill patients, and with boarding increasing in EDs, we need to know how to interpret waveforms. This instrument can provide a great deal of important information if properly understood.
Interpreting Waveform Capnography: Pearls and Pitfalls Read More »
Pulmonary embolism (PE) is a disease process associated with significant morbidity and mortality. The benefits of thrombolytics for massive PE has been established in the literature. But what does the evidence say about the use of thrombolytics for submassive PE? What are the current guidelines and recommendations? As emergency physicians how should we apply the current evidence for the use of thrombolytics in submassive PE?
Controversies of Thrombolytics for Pulmonary Embolism Read More »
Acute vision loss has a wide differential, and some of these conditions can cause permanent visual deficit. Many of these are time-sensitive, and the emergency physician may improve patient outcome through the consideration of several acute conditions. This post seeks to provide an overview of the evaluation of vision loss in the ED and a summary of several common conditions.
Acute Visual Loss in the Emergency Department: Pearls and Pitfalls Read More »
The transient ischemic attack (TIA) places patients at high risk for future stroke. This article reviews the current literature on the diagnosis, management and disposition of patients with TIA. The use of observation and TIA clinics is also discussed.
What else should we be thinking about when a patient with a history of recurrent vomiting presents to the emergency department with the same chief complaint today…
Cyclic Vomiting Syndrome: Pearls and Pitfalls Read More »
