practice updates

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.

CT: the donut of truth. Most physicians breathe a little easier sending a patient home with a negative CT abdomen/pelvis. However, the power of x-ray vision doesn’t allow us to turn off our brains. Certain pathologies may have only subtle findings on CT, and others may lend themselves better to other imaging modalities, such as ultrasound. By being aware of these pathologies and how to identify them, we can better recognize patients at risk of a missed diagnosis.

What do you think of with the patient presenting with fever, headache, and focal neurologic signs? Meningitis? Encephalitis? What about brain abscess? This post is filled with pearls and pitfalls on the pathogenesis, presentation, diagnosis, and treatment of brain abscess.

Common postpartum emergencies include hemorrhage, infections, hypertension, preeclampsia/eclampsia, and headache. HELLP and peripartum cardiomyopathy are rare postpartum complications. This article reviews the presentation of these emergencies and how they are properly diagnosed and managed in the emergency department.

We are masters of the airway, often managing life-threatening scenarios and conditions. However, the patient who decompensates around the time of intubation, or directly after the procedure, can be frightening. What can you do to mimize these events?

In previous discussions, we have addressed that IV fluid choices affect patient outcomes in septic shock, and we have shown the evidence that invasive monitoring coupled with aggressive treatments are actually harming our patients.

The question we now face is what is the result of over-resuscitation?

How do you interpret quantitative capnography waveforms? We own the resuscitation of critically ill patients, and with boarding increasing in EDs, we need to know how to interpret waveforms. This instrument can provide a great deal of important information if properly understood.

A commonly ordered test in the ED is the coagulation panel. What does this panel entail? Is there any evidence behind it for ED use? When should it be ordered? This post provides these answers and more.

Every provider has their own twist on the standard “headache cocktail”, but what is the evidence behind the individual medications for headache management? What about treating headaches in the pregnant or pediatric patient? This post seeks to answer these questions and more.

Complementing the recent atrial fibrillation post this week, dive into more pearls of atrial fibrillation management in the ED by our own Dr. Jennifer Robertson