practice updates

“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.

“Within the next decade, the incidence of CKD is expected to nearly double”

In this article, Matt Smetana, DO describes the common manifestations of hemorrhage in uremic patients, and then outlines strategies to stop the bleeding.

“Two independent variables associated with post-ETI arrest: Pre-induction shock index and weight”

Intubating beyond the ABCs: Learn how to support your crashing patient while providing definitive airway management. Zach Radwine, MD covers identification of patients at risk for hypotension, dealing with hemodynamic instability, and how to address the numerous complications that may arise.

“Despite the multitude of studies, the excellent results, and the commonplace use by anesthesiologists for decades, the use of push-dose pressors has not yet made its way into standard emergency medicine practice”

For a patient in shock, or with anticipated instability during procedural sedation, push-dose pressors can be a lifesaver. Brendon Browning, DO covers administration of pressors under circumstances in which central lines and infusions either aren’t available or aren’t needed.

“One of the essential instant recognition abnormalities on ECG”

Knowing how to spot Wellens’ morphology is crucial, but knowing when to expect those ECG changes is the other half of the battle. In this excellent article, Brendon Browning, DO covers the intricacies of this deadly entity, including diagnostic criteria, management pitfalls, and how to identify mimics.

“Some will not have a palpable pulse, and unfortunately, manual BP cannot be obtained. In addition, pulse oximetry is unreliable”

No pulse? No problem! Manpreet Singh, MD covers a stepwise approach to troubleshooting ventricular assist device complications in the emergency department.