While HIV medications receive much attention for the treatment of HIV infection, less attention has focused on the prophylaxis indications. In 2017, the Center for Disease Control and Prevention (CDC) updated their guidelines on the indications for the HIV medications tenofovir disoproxil fumarate (TDF) and emtricitabine (2′,3′-dideoxy-5-fluoro-3′-thiacytidine, FTC) for pre-exposure prophylaxis (PrEP). The trade name for the combination medication is Truvada. These daily medications are taken by people at risk for HIV to prevent HIV. This Guideline Review succinctly summarizes the 77-page CDC document into the key pearls for emergency physicians.
Did you get your flu shot? We hope so. Influenza season is upon us again and it is always helpful to review the latest 2018 Infectious Disease Society of America (IDSA) update on the diagnosis and treatment of influenza.1 Notable is that influenza-confirmed patients who present within 2 days of symptoms who are deemed low risk do not automatically warrant antiviral treatment. The subsequent question then is who is high risk? The following infographic by our Guidelines Editor, Dr. Kelly Wong, summarizes the key take-home points for emergency medicine clinicians.(more…)
Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.(more…)
The last American College of Emergency Physicians (ACEP) guideline recommendations regarding the use of propofol for ED procedural sedation was in 2007. Much research has since demonstrated its safety in adults and children. Furthermore, many clinicians are co-administering ketamine or fentanyl in conjunction. This 2018 ACEP update1 addresses these issues and much more. The following infographic summarizes the key points.(more…)
Blunt Cerebrovascular Injury (BCVI) can be difficult to diagnose and potentially devastating to miss because of the risk of a potential ischemic stroke. The most recent (2010) Eastern Association for the Surgery of Trauma (EAST) guidelines reviewed 68 journal publications to create the following recommendations based on the best available evidence.1 We summarize the imaging and management recommendations most pertinent to the ED as an infographic for quick and easy reference.1,2 Of note: an isolated neck seat belt sign is NOT an indication for imaging!
Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylactic measure, but the vaccine is not 100% effective due to mismatch between the circulating and vaccine virus strains. Although most individuals will recover from influenza without incident, some specific patient populations are at high risk for severe complications. The Infectious Disease Society of America (IDSA) recently updated their clinical practice guidelines.1 We review these key updates, including recommendations on who to test, treat, and provide chemoprophylaxis.
A patient presents to your ED with an all too common complaint – chest pain. After a focused history and physical exam, you have an extremely low clinical suspicion for thoracic aortic dissection, pulmonary embolism, pneumonia, pneumothorax, pericarditis/myocarditis, and Boerhaave’s syndrome. When the labs (including a troponin), an ECG, and chest x-ray yield normal results, questions often arise. Can you discharge her with a single troponin if she is low risk? How do you define low risk? And lastly, does she need urgent provocative testing after discharge?