Top 10 reasons NOT to order a CT scan for suspected renal colic

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLarger It appears that the excitement and utilization of computed tomography (CT) imaging in the emergency department (ED) has far outpaced our concern for the short- and long-term consequences of increased reliance on this technology. CT has greatly supplemented, or even replaced, our clinical decision making for many chief complaints. Many articles document the dramatic increased CT use in contemporary practice, including a 330% increase in the rate of CT imaging from 1996 to 2007. The likelihood of a CT order being part of any ED encounter now approaches 15%, with no signs of decline.¹

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By Daniel Firestone, MD RDMS|2016-11-11T19:20:03-08:00Apr 10, 2014|Expert Peer Reviewed (Clinical), Genitourinary, Radiology|

High Sensitivity Troponin T and Acute Myocardial Infarction: One and Done?

There has been a lot of publicity about evaluation of chest pain patients in the emergency department (ED) with high sensitivity troponin testing. In the past with older troponin assays, clinicians would evaluate patients, get an ECG, and an initial set of cardiac biomarkers. The subsequent set of biomarkers would be performed at 6-8 hours later before determination of disposition. In the past few years, several studies have been published evaluating point of care troponins, sensitive troponins, and high sensitivity troponins which have changed our practice and evaluation of these patients. An early version of a study was recently released in the Journal of the American College of Cardiology (JACC) stating that for ED chest pain patients, we may be able to discharge patients from the ED with an initial normal ECG and single high sensitivity troponin T (hs-cTnT). So is it true… one and done?

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By Salim Rezaie, MD|2019-09-10T13:34:11-07:00Apr 3, 2014|Cardiovascular, Expert Peer Reviewed (Clinical)|

Cellulitis: Do Not Get Blood Cultures

You are treating a patient with left lower leg cellulitis. The nurse is going to establish IV access, draw blood work, and give analgesia and antibiotics. Before walking into the room, the nurse asks, “Do you need me to grab a set of blood cultures?” Additionally the hospitalist had asked you to order a “set of cultures” on your most recent cellulitis admission. Should you proceed?

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By Jeff Siegler, MD|2016-11-11T19:19:44-08:00Apr 1, 2014|Dermatology, Expert Peer Reviewed (Clinical), Infectious Disease|

When the PERC Rule Fails

Kline et al developed a clinical decision tool based on parameters that could be obtained from a brief initial assessment to reasonably exclude the diagnosis of pulmonary embolism (PE) without the use of D-dimer in order to prevent unnecessary cost and the use of medical resources. ¹ Many of us have used the Pulmonary Embolism Rule-out Criteria (PERC) rule by now, but we should be clear on what it includes. Are we using it appropriately?

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By Jason West, MD|2016-11-11T19:19:14-08:00Feb 11, 2014|Cardiovascular, Expert Peer Reviewed (Clinical), Pulmonary|

Serotonin Syndrome: Consider in the Older Patient with Altered Mental Status

What’s the first thing that pops into your head when you see an older woman presenting to the ED from a nursing facility with atraumatic altered mental status? If you’re like me, ‘UTI’ comes quickly to mind. I then banish the thought of a UTI and force myself to go through a worst-first differential diagnosis to exclude, either through the history and clinical assessment or through testing, more dangerous causes. This is a case of a 67-year-old woman with an unusual cause of altered mental status… and a UTI.

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By Christina Shenvi, MD, PhD, MBA|2016-11-11T19:18:16-08:00Feb 3, 2014|Expert Peer Reviewed (Clinical), Geriatrics, Tox & Medications|

Head injury in pediatric patients: To CT or not to CT?

Intracranial injury is the leading cause of death and disability in children. It can arise after severe, moderate, or minor head injury. Children with minor head injury present the greatest diagnostic dilemma for emergency physicians, as they appear well but a small number will develop intracranial injuries. The question that often arises in the ED is:

To CT or not to CT?

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By Josh Easter, MD|2017-03-05T14:14:36-08:00Jan 23, 2014|Expert Peer Reviewed (Clinical), Pediatrics, Trauma|

Approach to Difficult Vascular Access

Intravenous (IV) access is a basic and invaluable skill for emergency physicians. For patients requiring rapid fluid resuscitation, airway management, or medication administration, the placement of one or more IV lines is absolutely essential. Most patients do well with a simple, landmark-based, blind placement of a superficial peripheral IV. However, we often encounter situations where this may be difficult or impossible to achieve, and so we all should have a repertoire of other sites and techniques to employ.

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By Terrance Lee, MD|2019-02-19T18:57:48-08:00Jan 15, 2014|Cardiovascular, Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

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