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Management of Boarding Psychiatric Patients in the ED

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A significant number of patients in the ED present with psychiatric complaints. Unfortunately, the resources available for these patients have not kept up with with the increase in psychiatric issues. Emergency medicine acts as a safety net for a large percentage of these patients. These patients present significant challenges to emergency providers. This post is full of pearls for providers managing the psychiatric patient.

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Current Controversies in TIA Evaluation

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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.

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PEM Playbook – Altered Mental Status in Children

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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).

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Rheumatoid Arthritis: Management and Complications in the ED

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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.

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The Controversies of Corticosteroids in Sepsis

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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.

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PEM Playbook – Big Labs, Little People: Troponin, BNP, D-Dimer, and Lactate

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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?

PEM Playbook – Big Labs, Little People: Troponin, BNP, D-Dimer, and Lactate Read More »

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