practice updates

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.

Tumor Lysis Syndrome: a condition associated with significant morbidity and mortality. These patients often present with vague symptoms. How do you make the diagnosis, and what are the keys in management? This post answers these questions and more.

The patient with penetrating trauma can present with many different injuries. The majority of injuries are easily diagnosed. What about the patient with pneumothorax, diaphragmatic injury, ureteral injury, and hollow viscus injury? These are not so easy to diagnose, and delay in management can cause significant morbidity and mortality. This post provides pearls and pitfalls for these conditions.

For all the rising trauma seniors out there about to take on heavier roles in their departments, tune in to read what you should keep in mind and hope to avoid for the blunt trauma patient.

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.

How do we manage his hemodynamics and when do we perform massive transfusion?

SBP is a hallmark of advanced liver disease with mortality estimates of 31.5% at 1 month and 66.2% at 12 months! With mortality rates that high, here are some ED management pearls about which emergency physicians should be aware.

Continuing with our EM Mindset series, here is another great piece by Dr. Joe Lex to kick off your week. Enjoy!

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.