recent articles

practice updates

D-Dimer in Aortic Dissection Workup

"Higher d-dimer levels correlate with more segments of the aorta involved, with false lumen type dissections, and with higher mortality rates"

D-dimer has great sensitivity for aortic dissection, but its true clinical utility in the workup of this high-risk diagnosis remains undefined. Tim Schaefer, MD reviews diagnosis and management, as well as the recent literature on the role of the d-dimer.

From @EMSwami

Epinephrine in Cardiac Arrest

"It’s time to re-examine this recommendation"
Epinephrine in cardiac arrest: helpful for ROSC, but maybe not so much for good neurological outcomes. Anand Swaminathan, MD MPH takes a thought-provoking look at the historical evidence behind this practice, as well as at newer evidence that calls its benefit into question.

practice updates

PERC Rule: Application and Limitations

"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.

practice updates

Synthetic Cannabinoids

"There have been a growing number of cases associated with life-threatening neurotoxic effects and cardiotoxic effects"
Cynthia Santos, MD gives a nice overview of the increasingly popular synthetic cannabinoids, including the range of clinical presentations, management, and the bottom line for your practice in the ED.

practice updates

Ketamine for Analgesia in the ED

"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.

practice updates

Update: Analgesia and Sedation in the Intubated ED Patient

"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.

practice updates

Carotid Artery Dissection

"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.