Category Archives: *PRACTICE CHANGING

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 , ,

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 , ,

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

Posted in *PRACTICE CHANGING, Urology | Tagged , , ,

1. A-1 (Analgesia First) Sedation for intubated patients

Practice Change:  WOW, we all need to be doing this TODAY. What we do in the ED DOES matter and is linked to a HUGE mortality benefit.  I will be using Fentanyl as the primary agent for pain control after … Continue reading

Posted in *PRACTICE CHANGING, Critical Care | Tagged , ,

3.  Intra-arterial Stroke Treatment: Finally has a positive study (or 4)

Practice Change:  These new intraarterial interventions WORK on patients with large ACA and MCA  strokes seen on imaging.  The NNT to provide a patient with functional independence is 8.  The window of intervention is increased up to 12 hours after last … Continue reading

Posted in *PRACTICE CHANGING, Neurology | Tagged