In the Literature

Vasopressor use in patients with sepsis has been studied extensively, with many calling for early, peripheral vasopressors. What is the literature behind this, and are patient outcomes affected? This post examines the studies for vasopressors in sepsis and more.

Your shift starts and all of your patients are bleeding! There is an MVC victim with a tense abdomen and traumatic brain injury, a patient with an upper GI bleed, a woman whose spontaneous vaginal delivery has turned into a post-partum hemorrhage, and a brisk epistaxis in the back hallway. You thank the triage nurse and begin resuscitative measures. What role does tranexamic acid (TXA) play in the treatment of these patients?

We’ve all heard the horror stories of the crashing aortic stenosis patient. These patients present significant challenges in the ED. How can you best manage these patients?

Lactate clearance has been a major focus in care of the septic patient. Why does lactate elevate in these patients, and what do you need to know for managing these patients?

It is essential for Emergency Physicians to know the standard of care for sexually transmitted infection (STI) treatments, as patients often present to Emergency Departments for evaluation and treatment shortly after exposure to these diseases. The Emergency Department provides patients with rapid screening, diagnosis, treatment regimens, and access to outpatient follow up.

We have dealt with Ebola, Dengue, and Chikungunya. Introducing the new kid on the block: Zika Virus.

What do you do with the head trauma patient who is anticoagulated? Do you discharge the patient, observe and repeat CT, or admit the patient? This post evaluates this question and more.

In 2002, a new standard of care was established when the Surviving Sepsis Campaign (SSC) highlighted the importance of recognizing sepsis and initiating treatment early. Once we find that a patient meets Systemic Inflammatory Response Syndrome (SIRS) criteria with a source of infection, rapid and appropriate treatment including resuscitation is a must. Early fluid resuscitation is necessary for septic patients, but there is large variance on the aggressiveness of fluid resuscitation. There is disagreement amongst the experts on the total amount of fluids that should be administered and the end points for resuscitation. We must ask ourselves, at what point does our aggressive resuscitation actually start to harm our patients?

Does your choice of fluids for resuscitation in sepsis matter? Multiple studies have been performed to determine whether septic patients benefit from colloid versus crystalloid IV fluids, and other studies have specifically looked at the different kinds of fluids within those specific groups. Debate now exists as to which fluid will improve patient outcomes.