Ottawa Subarachnoid Hemorrhage Rule

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The article: Perry JJ, Stiell IG, Sivilotti ML, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013;310:1248-1255.

The bottom line: Use of the Ottawa subarachnoid hemorrhage rule in the ED to help determine which patients need workup for possible SAH decreases the rate of missed SAH and allows clinicians to safely classify patients meeting none of the criteria as low risk. However, the rule does not decrease the investigation rate of SAH and still need ...

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ED EEGs for Uncomplicated First-Time Seizure

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The Article:

The First-Time Seizure Emergency Department Electroencephalogram Study. Wyman et al. (2017) Annals of Emergency Medicine. 69(2):184-191.

The Idea:

To determine whether obtaining an EEG in the ED after first time uncomplicated seizure could identify patients with epilepsy as candidates for immediate initiation of an antiepileptic drug (AED) on discharge.

The Study:

A prospective trial of a convenience sample of patients presenting with an uncomplicated first time seizure at a single tertiary care center in North Carolina. Inclusion criteria included all patients over age ...

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Ketamine for agitation

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The Article: 

Ketamine as a first-line treatment for severely agitated emergency department patients. J Riddell et al. American Journal of Emergency. 2017 Feb 13. pii: S0735-6757(17)30114-6.

 

The Idea:

Rapid control of the severely agitated person in the ED is important for both patient and staff safety. Benzodiazepines and haloperidol are commonly used first line agents that have draw backs. Ketamine may be a faster, more reliable option, and has been shown to be effective in the prehospital setting.

The Study: 

A single-center, prospective, observational study ...

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Suicide Assessment in the ED

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The Article:

Literature based recommendations for suicide assessment in the Emergency Department: A review. The Journal of Emergency Medicine, Vol. 43, No. 5, pp. 836–842, 2012

Linda Ronquillo, MA, Arpi Minassian, PHD, Gary M. Vilke, MD, and Michael P. Wilson, MD, PHD.

 

The Background:

Suicidal ideation and suicide attempts are frequent complaints in the ED. The Joint Commission established a National Patient Safety Goal that requires practitioners who are taking care of patients ...

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Ottawa Heart Failure Score

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Posted by: Kelly Goodsell

The article:

Steill, IG et al. “Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, with and without use of Quantitative NT-proBNP”.  Academic Emergency Medicine. 2017 Mar;24(3):316-327. doi: 10.1111/acem.13141.

 

Background:

-CHF exacerbation/acute heart failure (AHF) is a common ED complaint, accounts for a lot of admissions and healthcare $

-some of these admissions may be unnecessary

-quality evidence to inform potential dispo guidelines for these pts previously lacking

-the Ottawa Heart Failure Risk Scale (OHFRS) –previously derived scoring system for ...

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Consideration of PE in Syncope

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The Article:  Prandoni P et al. Prevalence of Pulmonary Embolism Among Patients Hospitalized for Syncope. NEJM 2016; 375(16): 1524 – 31.

The Idea:
Syncope is a common and yet often difficult chief complaint, with no gold standard test and no validated decision guideline. ED and inpatient workups are frequently low yield. PE is one of several more concerning possible diagnoses to consider, but there has previously been little evidence on its prevalence in syncopal patients. The PESIT trial published in 2016 attempted to ...

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Cardiac Risk Scores and Missed Myocardial Infarction

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The Article:

Missed myocardial infarctions in ED patients prospectively categorized as low risk by established risk scores.

Singer et al. (2017) American Journal of Emergency Medicine.

The Idea:

Risk scoring for patients with chest pain and concern for ACS has been used to reduce unnecessary admissions and minimize the risk of adverse outcomes for discharged patients. These authors sought to compare a number of these scores with clinical gestalt as techniques to detect myocardial infarction, in conjunction ...

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Bolus Dosing Nitroglycerin in Acute Heart Failure

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The Article

 

Wilson, S. S., Kwiatkowski, G. M., Millis, S. R., Purakal, J. D., Mahajan, A. P., & Levy, P. D. (2017). Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. The American Journal of Emergency Medicine,35(1), 126-131. doi:10.1016/j.ajem.2016.10.038

 

The Idea

Although vasodilators have only been shown to improve symptoms, with no apparent benefit on mortality and hospital readmission they remain our first choice in acute heart failure with hypertension. Nitroglycerin is one of the ...

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POKER Trial

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The Article: Ferguson I et al. Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine – The POKER Study: A Randomized Double-Blind Clinical Trial. Ann Emerg Med. 2016, 68 (5): 574-582.

The Idea: A 1:1 mixture of propofol and ketamine (Ketofol) would decrease adverse effects compared to when propofol is used alone for deep sedation in the emergency department.

The Study:

– Randomized, double-blind trial of adult patient requiring deep sedation in the emergency department at three Australian hospitals.

 

– 591 Patients ...

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Discharge glucose is not associated with short-term adverse outcomes in Emergency Department patients with moderate to severe hyperglycemia

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Article:

Discharge glucose is not associated with short-term adverse outcomes in Emergency Department patients with moderate to severe hyperglycemia. Driver, et al. Ann Emerg Med. 2016 Dec.

Objective:

Hyperglycemia is a commonly encountered occurrence in the ED. However, there is no consensus among EM physicians regarding what the “safe” cutoff is for discharge glucose levels. There are currently no established guidelines for EM physicians to follow, and therefore, most practitioners have developed variable cutoffs of what they deem ...

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