practice updates

“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.

“Balance between bleeding and thrombosis”

Novel medications like dabigatran and rivaroxaban are increasingly being used to treat patients requiring anticoagulation, but management of bleeding can be a real challenge. Jake Rabe, MD discusses recent trials and reversal strategies.

“The clinical picture is a mix of ARDS and air embolism”

Zara Mathews, MD covers the subject of blast injuries, including a review of the basics, important updates in the workup of these patients (for example, tympanic membrane rupture is not a great predictor of injury), and common pitfalls in management.

“Psychosis that can last for days to weeks”

Unless your patient on bath salts is very forthcoming, you may be on your own when making this clinical diagnosis. Be prepared with this primer on cathinones by Kyle Brown, MD.

A practice update on adult epiglottitis in the ED.