recent articles

perspectives

Dr. Strangelove or How I Learned to Stop Worrying and Sit on the qSOFA: A pathophysiologic approach to qSOFA

The last few months have seen an enormous amount of controversy in the press, in the FOAMsphere, and in our ED hallways regarding the new consensus sepsis definition. The goal of this post is not to rehash the strengths and weaknesses of Sepsis 3, but rather to explore the pathophysiologic basis of the simplified clinical features of sepsis outlined in the qSOFA score, which might explain why the definition shook out the way it did. Hopefully, such an understanding will help us apply lessons learned from the derivation of Sepsis 3 to the management of these profoundly sick patients.

EM Cases

Alcohol Withdrawal: Pearls and Pitfalls

Alcohol use is extremely widespread throughout developed countries. It is estimated that 8 million people in the US are alcohol dependent. Approximately 20% of men and 10% of women will at some point in their lives have an alcohol-use disorder. About half of people with alcohol-use disorders will have symptoms of withdrawal when they cut down or stop their alcohol consumption. Extreme complications, including seizures and/or delirium tremens, will occur in 3-5% of these people.

practice updates

Commonly Missed Findings on CT Abdomen/Pelvis

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.

clinical cases

A Case of Non-bacterial Thromboembolic Endocarditis

A 59 year-old male presented to the emergency department with a chief complaint of difficulty concentrating and loss of vision. He had presented to the same facility the day prior for chest pain, chills, and a cough. During his prior visit, the patient underwent a chest x-ray which demonstrated a consolidation suggestive of a lobar pneumonia and was subsequently discharged home with a prescription for Azithromycin as well as instructions to follow-up with his primary care doctor. However, he was unable to fill his prescription. Upon attempting to drive home, the patient was pulled over by law enforcement because he was acting “delirious.” Despite the traffic incident, he was allowed to return home. The patient reported that once he arrived at home he began bumping into furniture, experiencing difficulty with concentration, and suffered vision loss. In addition, he continued to experience chills, chest pain, and shortness of breath.

practice updates

Abdominal Vascular Graft Complications

As trainees I think it is beaten into our heads that all males over the age of 50 with new onset hematuria and flank pain should also be screened for AAA. One thing that is not so much beaten into our heads is how we still have to take hematuria and or hematochezia seriously in these same patients even after they receive endovascular repair. There are many complications that can occur from having an aortic graft placed, but for the purpose of this article let’s focus on Aortoenteric fistula and Endoleaks.

practice updates

BNP Level in the Emergency Department: Does it Change Management?

BNP (Brain Natriuretic Peptide) is a commonly used biomarker for detecting heart failure in the emergency department. It's levels can be affected by various extraneous factors such as obesity and renal failure. This article reviews the potential uses of BNP, including its pros and cons, in the emergency department.

practice updates

Nausea and Vomiting in Pregnancy: EM management

The pregnant patient with nausea and vomiting is something most providers want to avoid. A wide range of conditions can cause these symptoms in the pregnant patient, and these conditions can range from the benign morning sickness to life-threatening preeclampsia and acute fatty liver of pregnancy. What can you do to manage these patients while diagnosing severe disease?