recent articles

practice updates

The Wheeze That Wasn't – An Observation on Enterovirus D-68

These children are often a mixed picture of viral bronchitis/bronchiolitis PLUS an asthma exacerbation. Treatment with albuterol, ipratropium, magnesium sulfate, steroids, fluids, etc are all reasonable and prudent in this population. If they begin to clinically improve within 30 minutes then you can feel good about soothing their reactive airways. However, they still have underlying viral issues which may require non-invasive positive pressure ventilation (either high-flow nasal cannula or BIPAP). If they do not improve within 30 minutes then you should begin to plan for IMC/ICU admission as these patients will require significant monitoring and respiratory support.

practice updates

The Future of Emergency Medicine Education

Trying to predict the future is a task that is riddled with risk. There is a very high potential that I will be wrong and my thoughts will end up being complete baloney. I'm okay with this. According to Strengths Finder 2.0, I'm futuristic, meaning that I'm inspired by the future and what could be, and hopefully will inspire you. With this in mind, two quotes that I believe should frame our conversation: "The future is already here, it's just not very evenly distributed." -William Gibson "We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10." -Bill Gates With these in mind, here are some trends that I see emerging. [...]

practice updates

Acute Aortic Dissection

Aortic dissection is a life-threatening yet infrequent diagnosis, estimated at about three cases in every 100,000 person years (1,2). Because of its low frequency and emergency nature, large randomized controlled trials are difficult to conduct (3). Thus, the International Registry of Acute Aortic Dissection (IRAD) was established in 1996 to obtain up-to-date data on patients with acute aortic dissection. Currently, 30 large referral centers in 11 countries participate. Most novel research on aortic dissection is based on IRAD data. [...]

practice updates

Ultrasound for Small Bowel Obstruction

Editor's note: This article was listed in EM Curious' #FOAMed Review 19th Ed.

Quicker diagnosis (vs waiting for CT), quicker treatment (IVF, NG tube, surgery), and earlier consult/admission to Surgical team. Everyone benefits: ED flow, overburdened nurses, other patients requiring attention in the ED, and most of all, the patient himself.

practice updates

Wrist Injuries: Pearls and Pitfalls

Wrist pain is a frequent emergency department complaint. Most presentations are due to an acute traumatic injury. Furthermore, overuse or repetitive motion mechanisms cause ED visits for either an acute injury or an exacerbation of chronic pain conditions. For the purposes of this post, the wrist is going to be defined as injuries occurring to the distal radius and ulna, as well as any injury to the carpal bones. In addition, I feel it to be a poor use of this forum to simply list every conceivable form of wrist injury. Instead, I’d like to discuss the following:

  • Pertinent questions you need to ask your patient when evaluating a wrist injury
  • Pain management techniques including hematoma blocks
  • Which fractures have a higher likelihood of developing avascular necrosis
  • What type of splint is indicated for a particular injury

practice updates

Thromboelastography (TEG®) for Trauma

Editor's note: This article was listed in LITFL Review 154's "Best of #FOAMcc Critical Care" section.

Using thromboelastography in goal-oriented algorithms, clinicians may be able to optimize targeted transfusion therapies with specific coagulation factor(s) instead of empirically administering multiple components with potentially hazardous effects.