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Shift Pearls: Acute Heart Failure Exacerbation Disposition

Shift Pearls returns with disposition of the ED patient with heart failure exacerbation.

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    • practice updates

    Acute Aortic Dissection

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    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
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    Ultrasound for Small Bowel Obstruction

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    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
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    Wrist Injuries: Pearls and Pitfalls

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    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
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    • practice updates

    Naloxone in the News: Time to Address our Opioid Abuse Problem

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    Naloxone has been proven to reduce the incident of death in acute opioid overdoses. So why aren't we using it more often?
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    Thromboelastography (TEG®) for Trauma

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    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.

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    Bounceback: An Unrelenting Headache

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    CC: Headache First visit HPI: 29 year old female with a prior history of headaches, presented with two days of gradual onset, atraumatic, right sided headache that is throbbing in nature. The patient reported heaviness about the eye but no visual changes or disturbances. No neck pain, fevers, chills. She
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    Acute heart failure exacerbation disposition

    Not all patients require admission

     

    Consider patient hemodynamics, respiratory status, ECG, labs (Cr, troponin, sodium/electrolytes), ability to ambulate, follow up

     

    Elevated troponin and serum Cr associated with worse outcomes

     

    Don’t use risk tools alone for DC, but Ottawa Heart Failure Risk Scale may assist in admission (ACEP Level B)

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