FOAMED

Do you tweet during conference or lecture? This post evaluates the pros and cons of live-tweeting.

Having difficulty determining whether or not your GI bleeder is stable for the floor? Read on as we discuss risk stratification tools and risk factors for severe GI bleeds.

Managing Sexual Assault in the Emergency Department
This review will address patient stabilization, provide recommendations for obtaining a medical and assault history, and detail pregnancy and sexually transmitted infection prophylaxis. An in-depth discussion of the forensic examination will be omitted, as requirements regarding healthcare provider training, tools contained within forensic collection kits, time allotted between alleged assault and court admissible evidence collection, and chain of custody legislation vary according to individual state law.

Third trimester pregnant patients are not seen commonly in the emergency department, but when they are, they have the potential for severe complications such as hemorrhagic shock. This article reviews the most serious causes of bleeding in the third trimester of pregnancy and also discusses management options.

Patients who undergo elective abortions may present to the emergency department for various symptoms and complications due to their recent procedures. This is a brief article of the complications of elective abortion. Workup and management of these complications are also reviewed.

Intubation, especially in the septic and critically ill patient, can, by itself, cause hemodynamic abnormalities and/or hypoxemia and hypercapnea. In some situations, it may be important to make sure that the patient is adequately prepared for intubation, both from hemodynamic and pre-oxygenation standpoints. This is a brief review of some suggestions when intubating the very ill patient in the emergency department.

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.

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.

Based on the available data, it does not appear that cervical collars have any appreciable positive effect on patient care. However, at this point in time, they are the recommended treatment option. Hopefully this knowledge will help your daily practice by understanding the effects of cervical immobilization.

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.