practice updates

“Pleuritic chest pain […] is not in a validated clinical decision rule despite having a higher OR for PE than hemoptysis and recent immobilization”

The PERC rule can be a wonderful thing, but requires judicious use. Jason West, MD reviews the literature, discussing applicability and limitations of the PERC rule, so you’ll know when to feel confident foregoing the D-dimer and when to be more cautious.

“Ketamine provides excellent analgesia with no or minimal effects on perception or emotion”

We are very excited to bring you a post from Reuben Strayer, MD (@emupdates) on ketamine as an alternative to opiates for pain relief in the ED. The discussion highlights indications for use, dosing recommendations, and how to avoid potentiating the medication’s psychiatric effects.

“Targeting light sedation within the first twelve hours of intubation decreases morbidity and mortality”

Taking a thoughtful approach toward keeping your intubated patient comfortable is not just the humane thing to do – it can make a big difference in their ultimate outcome. Rachel Shard, MD discusses strategies for pain relief and sedation in these patients, including prioritization of analgesia and the pros/cons of propofol, benzos, and dexmedetomidine.

“Some have questioned exactly which parts of the bundle are beneficial, which parts are not, and which parts may be causing harm”

Steven Whelpley, DO reviews the recent literature on sepsis recognition and treatment in the ED.

“Significant cause of strokes in young/middle aged patients”

Olabiyi Akala, MD summarizes the signs, symptoms, and imaging options for making the diagnosis of carotid artery dissection, and discusses current controversies in management.

“Recent studies have suggested that the timing of surgery may be less important for overall outcomes. Rather, outcomes may be more related to the extent of cord compression at presentation”

Jennifer Robertson, MD, MSEd brings us an update on cauda equina syndrome, including making the diagnosis, timing of surgery, and medicolegal risks.

Rachel Wightman, MD presents the case of a 33 year-old female with two days of pelvic and rectal pain.

“PALM-COEIN separates the differential for vaginal bleeding into structural and non-structural causes”

Jason Kan, MD covers the various causes and ED management strategies for severe vaginal bleeding in non-pregnant patients.

“There has been ongoing controversy regarding the ratio of components that should be given during massive transfusion”

How do you avoid inducing a coagulopathy in trauma patients requiring massive blood transfusion? Zach Radwine, MD summarizes the recent evidence for the 1:1:1 ratio.

“Think about these substances in a patient with either an opioid, sympathomimetic, or hallucinogenic toxidrome”

Alex Koyfman, MD summarizes the assorted clinical presentations of these three “legal” highs.