Author Archives: plw6y

Sepsis for CMS

On Oct 1, 2015 CMS began requiring hospitals to report their data on how they meet certain metrics for patients with “severe sepsis” via Sepsis Bundle Project v 5.0a. As with everything CMS, the details are things we need to … Continue reading

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EM ONE – September Update – Changing SUX to ROC

So this post is not about new data, but a new way of practicing emergency medicine.  Our EMS system will be switching from using Succinylcholine (SUX) to using Rocuronium (ROC) on selected intubated patients next month. Below is the data behind the decision, which … Continue reading

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Rocuronium vs Succinylcholine for Intubation

Practice Changer: I will be using ROC at 1.2mg/kg in my ED patients who do NOT require repeat neurological examination.  It has no contraindications, is equally effective to SUX, and will give me LONGER SAFE APNEIC TIME to secure the airway. … Continue reading

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EM ONE – August Update – Cardiology

Hey Everyone – Our recently adopted HEART score has a new twist, the HEART Pathway, that may be perfect for US ED use.  While our cardiology colleagues may have fewer chest pain consults, the new AHA guidelines for out of hospital … Continue reading

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PCI after Cardiac Arrest

Practice Change:  After an ECG, ABG, and beside electrolytes all comatose post-arrest patients with ROSC should be discussed with the cardiologist for emergency PCI – up to 25% may benefit.  Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient JACC – … Continue reading

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HEART PATHWAY for Cardiac Risk

Practice Changer: The HEART Pathway is a simple cardiac risk assessment tool that is designed for use in the ED.  It’s safe and effective at classifying patients as low risk for outpatient evaluation of cardiac disease while also decreasing length of stay and … Continue reading

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EM ONE – July Update – Shhhh… the baby’s sleeping!

To Clot or NOT to Clot? July 2015 Articles Reviewed Age Adjusted D-dimer in PE evaluation ** Tranexamic Acid in Trauma CRASH II – initial protocol** Timing is important!** Head Injury In a trauma system Military Data (less applicable, but supportive … Continue reading

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1. Age Adjusted D-Dimer in PE Rule Out

 Practice Change: An age adjusted d-dimer cut off for PE evaluation is a safe and effective way to evaluate patients over 50 years old for PEs.  I think we should talk to the lab about changing how we report our … Continue reading

Posted in *PRACTICE CHANGING, Pulmonology | Tagged , ,

2A, 2B: Tranexamic Acid and CRASH-II

Practice Change: If Tranexamic Acid is not on your short list of life saving medications in trauma, it should be!  It is inexpensive and has a mortality benefit in hemorrhaging trauma with a NNT of 67 to save a life.   … Continue reading

Posted in *PRACTICE CHANGING, Trauma | Tagged , ,

2C. TXA in Head Injury?

What About Use In Head Injuries? Take Home: Our system’s trauma protocol suggests stopping TXA once there is a head injury discovered, BUT given this data, I wouldn’t be too worried that we had caused harm in the patient by … Continue reading

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2D. TXA in Mature Trauma System

Take Home: TXA works in an established trauma system. – Annals of Surgery 2015 Study: Prospective Observational Cohort done in England of patients while their trauma system initiated use of TXA therapy in their Massive Transfusion Protocols Patients: Trauma patients … Continue reading

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2E. Military TXA Studies – TXA looks good in multiple settings.

Military Studies  Take Home: TXA seems effective in multiple settings and multiple studies. There are several other studies evaluating TXA in a military setting. TXA does seem effective in these studies as well, but because the protocols are different and they … Continue reading

Posted in Trauma | Tagged , ,

EM ONE – June 2015 Still Up All Night – Urology Dogma Challenge Especiale!

Kidney Stone Dogma Challenge Here is the June Late Night Lit Review. There have been several good, potentially practice changing, articles on the management of kidney stones in the last year. I decided to do a deep dive on the … Continue reading

Posted in Monthly THUMBNAIL

1. US for Kidney Stones is Safe and Effective

Practice Change: In patients I suspect of having renal colic, an US will be my first imagining study.   I can always get a CT later if I’m not satisfied with the workup. I may talk to the patients about possible … Continue reading

Posted in *PRACTICE CHANGING, Urology | Tagged , ,

2. A Normal Renal Ultrasound IS helpful

Take Home:  Sometimes a negative study is harder to explain to patients than positive studies. These two studies give me a chance to say “Great! Your chance of passing this kidney stone on your own is almost 100%” if I get … Continue reading

Posted in Urology | Tagged , ,

3. Tamsulosin (Flomax) does NOT help pass kidney stones

Practice Change: I will no longer prescribe Flomax for kidney stones.  Medically expulsive therapy of stones appears ineffective.  Our urologists seem to like these medications, and I think we should have a discussion with them about their use. Tamsulosin (Flomax) and … Continue reading

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4. Best Pain Medications in Renal Colic?

Take Home: For patients with renal colic, I will use both an NSAID and opiate up front for pain control.  This study has some problems with dosing, but overall supports a practice that makes intuitive sense. Systematic review of the relative efficacy of non-steroidal … Continue reading

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5. Lidocaine for Renal Colic Pain Control

Take Home: Lidocaine IV seems like a reasonable, “non-opiate” alternative therapy for patients with reasons to not want to provide opiates.  (high opiate tolerance, pregnancy (category B), or suspected abuse). It is just one study, but an interesting alternative I will use. … Continue reading

Posted in Urology | Tagged , , , ,

6. Do IV Fluids Make Stones Pass?

Take Home: It doesn’t appear that the small amount of available evidence supports this practice. If the expected effect was huge, I’d expect to see some hint of it in these small studies.  I’ll still treat dehydration from persistent vomiting … Continue reading

Posted in Urology | Tagged , ,

EM ONE – May 2015 Late-Night BABY ROCKING Literature Review

Here is this month’s Late Night with a crying baby literature scavenger hunt.  I tried to pick a few things that can hopefully help with your practice TODAY and one that we need to consider for the future.  Hope these help! May … Continue reading

Posted in Monthly THUMBNAIL