practice updates

TIA is a brief neurologic deficit due to cerebral ischemia, with no permanent infarction. It affects over 200,000 U.S. patients per year and may precede 14% to 23% of strokes. Many have sought risk stratification tools to determine who may be appropriate for discharge with follow-up. This post evaluates the new ACEP guidelines for TIA and the controversies in the ED evaluation of TIA.

Allergic reactions are commonly seen in the emergency department and anaphylaxis is the most severe type. While most patients present with a rash, the diagnosis can be difficult to make when a rash is not present. This is a brief overview of the diagnosis and management of anaphylaxis in the emergency department.

Altered mental status in children can be subtle. Look for age-specific behaviors that range from irritability to anger to sleepiness to decreased interaction.
In the altered child, anchoring bias is your biggest enemy. Keep your mind open to the possibilities, and be ready to change it, when new information becomes available.
For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke).

Rheumatoid arthritis is a progressive systemic polyarticular inflammatory arthritis of unclear etiology. While the disease itself is not fatal, complications of the disease make it the most common rheumatic disease requiring ICU admission. This article covers the management of this disease and its complications in the ED.

Suprapubic catheters are a more invasive type of catheter that have specific indications. Patients typically have these long-term and may present to the emergency department with complications related to their catheters. This is a brief overview of some complications of suprapubic catheters and how to manage them.

Sepsis is a condition emergency providers manage daily and has the potential for high morbidity and mortality. Sepsis management requires rapid diagnosis, early administration of intravenous (IV) fluids with broad-spectrum antimicrobials, and source control. But what is the role for steroids in sepsis? What are the potential benefits and risks? This post will explore the evidence surrounding corticosteroids in sepsis management to help shed some light on this controversial topic.

It’s a busy shift. Today no one seems to have a chief complaint.
Someone sends a troponin on a child. Good, bad, or ugly, how are you going to interpret the result?
And while we’re at it – what labs do I need to be careful with in children – sometimes the normal ranges of common labs can have our heads spinning!
Read on for bread-and-butter pediatric blood work and further, to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids?

On first glance, you observe active bleeding from the bilateral nares. Direct pressure has obtained hemostasis.

What is your next step? Topical vasoconstrictors? Nasal packing? Can this patient go home, or does he need to be admitted?

Let’s discuss a few key points about the management of posterior epistaxis.

Motorcycle accidents can be deadly. Riders are at high risk of injury due to the dangers of riding a motorcycle, which are vastly different from other vehicles. This post is full of pearls and pitfalls on motorcycle crashes and how to care for these patients.

The purpose of this article is to present a discussion on Lyme using a case based format. The goal is to expand the reader’s differential to include Lyme disease in a multitude of cases, provide tips/tricks for diagnosis and treatment, discuss the role of prophylaxis, and address Chronic Lyme Disease.