Shock Index: A Predictor of Morbidity and Mortality?

Emergent airway management and severe sepsis are both high-risk situations that are commonly encountered by emergency physicians. It is well known that complications can be high in both situations, which in turn can lead to increased morbidity and mortality. For instance, about 1/4 of patients who are hemodynamically stable prior to intubation get post-intubation hypotension (PIH) after rapid sequence intubation. Also septic patients may not be reliably identified by systemic inflammatory response syndrome (SIRS) markers early in their disease course. The Shock Index (SI) may be an adjunct that is easy to calculate and could predict both PIH and severe sepsis.

(more…)

By Salim Rezaie, MD|2019-09-10T13:35:16-07:00Nov 25, 2013|Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

ALiEM Journal Club Question 1: Bias

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 1 on the topic of bias:

The authors use distinct methods for tallying computed tomography (CT) use in the 2 countries. List the biases that could occur in counting CTs by each method.

(more…)

By Michelle Lin, MD|2019-01-28T21:52:13-08:00Nov 19, 2013|Expert Peer Reviewed (Clinical), Journal Club|

All Benzodiazepines are Metabolized by the Liver

We sometimes hear information stated as fact that may not be entirely accurate. One such example is, “I’m going to use lorazepam because it isn’t metabolized by the liver.”

Let’s set the record straight.

ALL benzodiazepines are metabolized by the liver.

(more…)

By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-01-09T17:17:06-08:00Nov 13, 2013|Expert Peer Reviewed (Clinical), Tox & Medications|

Thyroid Storm: Treatment Strategies

The Case

You have a 54-year-old female who presents to the emergency department with a chief complaint of “just feeling out of it.” She has felt “off and on” for the past 12 hours and has had an occasional cough with some sputum production along with “the shakes and chills.” She also feels as if her heart was “going at a mile a minute” and because of this, she is very much out of breath.

(more…)

By Nadia Awad, PharmD, BCPS|2018-10-28T21:35:33-07:00Nov 11, 2013|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Tox & Medications|

Discussing Annals EM article: Social Media and Physician Learning

I was delighted to see the News and Perspectives piece in this month’s Annals of Emergency Medicine about “Social Media and Physician Learning” (free PDF). I had totally forgotten that Jan Greene, the author, had called to talk with me several months ago. In the piece, she discusses many of the issues with which I struggle:

Is peer review good or bad?
What is the role of blog and podcast sites in the future of medical education?
With the ease of how anyone can be “published” on blogs, how can one decide on the trustworthiness of open educational resources such as FOAM?
Can or should social media education practices be held up to the rigorous scientific standards of original research?

Here are some noteworthy quotes:

(more…)

By Michelle Lin, MD|2019-01-28T21:52:47-08:00Nov 5, 2013|Expert Peer Reviewed (Clinical), Medical Education, Social Media & Tech|

5 Tips in Managing Acute Salicylate Poisoning

Salicylate is among the top 25 substances that cause the greatest number of overdose fatalities in the United States. ¹ Patients can present with a wide variety of complaints including tinnitus, dyspnea, vomiting, confusion, and coma. Significant toxicity occurs when a large amount of salicylate saturates the body’s protein-binding capacity and leaves free salicylate in the serum. ² The American College of Medical Toxicology (ACMT) recently published a guidance document on management priorities in salicylate toxicity, and it’s definitely worth a read. ³ While not an official clinical guideline, it highlights some important concepts to consider when working up and treating patients after a significant salicylate exposure, and we’ll review five major concepts here and hopefully answer some questions that may cross your mind on shift.

(more…)

By Kristin Fontes, MD|2016-11-11T19:04:19-08:00Nov 4, 2013|Expert Peer Reviewed (Clinical), Tox & Medications|

Putting an Older Patient Under: Tips for Geriatric Procedural Sedation

An 84-year old woman presents to your ED with a traumatic, left-sided posterior hip dislocation. You need to reduce the hip. But how should you sedate her? Procedural sedation is an important component of ED care. It allows us to more comfortably perform otherwise painful procedures such as fracture or dislocation reductions, endoscopies, large laceration repairs, and I&Ds. How safe is procedural sedation in older adults?

(more…)

By Christina Shenvi, MD PhD|2017-03-05T14:18:37-08:00Oct 31, 2013|Expert Peer Reviewed (Clinical), Geriatrics, Tox & Medications|