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Rezaie’s Evidence-Based Evidence of the Literature

1 06, 2013

RUSH protocol: Rapid Ultrasound for Shock and Hypotension

2017-04-11T16:33:21+00:00

Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for the evaluation of critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states.

The RUSH Protocol was first introduced in 2006 by Weingart SD et al, and later published in 2009. It was designed to be a rapid and easy to perform US protocol (<2 minutes) by most emergency physicians.

How do you perform the RUSH protocol?

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29 05, 2013

Out-of-Hospital Cardiac Arrest and Prehospital Intubation

2016-11-11T18:37:18+00:00

Worldwide, death from cardiac arrest in the out-of-hospital setting remains the leading cause of mortality. Focuses have aimed at improving bystander CPR, public access to AEDs, minimizing chest compression interruptions, and decreasing the emphasis on advanced airway management. This latter concept has become so important that the AHA/ASA have now changed their “ABC” philosophy to “CAB.” Below is the review of the literature that has changed this philosophy.

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14 05, 2013

Three predictors for success in cardiac arrest resuscitations

2016-11-11T18:38:34+00:00

The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes.  Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with good patient outcomes.

8 05, 2013

Pediatric Appendicitis: CT or Ultrasound?

2016-11-11T18:38:35+00:00

Appendicitis is the most common pediatric surgical emergency accounting for 5% of urgent pediatric outpatient visits for abdominal pain. Computed tomography (CT) and ultrasonography (US) are two imaging modalities used in the diagnostic evaluation of acute pediatric appendicitis. Both have decreased the incidence of negative appendectomy results. It is well known that CT has greater diagnostic accuracy than US for diagnosing acute appendicitis, but there is concern over long-term cancer risk, with routine use of CT in children.

What modality should be used for pediatric patients who are suspected of appendicitis?

1 05, 2013

Transient Synovitis vs Septic Arthritis of the Hip

2016-11-11T18:38:43+00:00

Limping is a common reason for parents to bring their children to emergency departments. It is known that 77% of acute, atraumatic limp is dealt with in the ED, and 20% do not even complain of pain.1 Our job as physicians is to complete appropriate assessments to not miss any serious pathology. Specifically, differentiating between transient synovitis (TS) and septic arthritis (SA) of the hip can be difficult and frustrating for everyone. What is your approach?

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25 04, 2013

The SCRAP Rule: Indications for chest CT in blunt trauma

2016-11-11T18:38:43+00:00

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLargerAt my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 1 looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment.