High risk back pain: Cauda Equina Syndrome (EREM)

Cauda equina syndrome (CES), which occurs due to compression of the distal lumbar and sacral nerve roots, is a potentially devastating cause of back pain. CES is often missed on the patient’s initial visit which can lead to significant neurologic compromise in a matter of hours [1]. To improve patient outcomes and minimize medicolegal risk, providers need to understand the limitations of the history and physical and carefully consider the diagnosis of CES in any patient with back pain.

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By Matthew DeLaney, MD|2016-12-20T11:19:57-08:00Jun 9, 2014|Medicolegal, Orthopedic|

Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers?

Rate control with IV medications is recommended for atrial fibrillation in the acute setting in patients without preexcitation. This was a Class 1 recommendation (Level of Evidence B) per the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation [1]. What does the evidence say? Are calcium channel blockers or beta blockers better?

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2022-02-10T10:59:25-08:00Jun 4, 2014|Cardiovascular, Tox & Medications|

Simulation Trick of the Trade: Bleeding Cricothyroidotomy Model

One advantage of simulation as an educational tool is the re-creation of cognitive and emotional stresses in caring for patients. Doing this for a high fidelity scenario is relatively easy – add additional patients, make a them loud, combative, or otherwise cantankerous, and add interruptions for good measure. However, when training for procedures in the simulation lab, we practice the procedure in isolation on a “task trainer” without cognitive and emotional stress for context. An off-the-shelf task trainer can do a superb job of teaching the mechanics of performing a procedure, but they lack complexity necessary to train for performing the procedure under stress. (more…)

By Jeffrey Hill, MD|2016-11-11T19:21:07-08:00Jun 3, 2014|Medical Education, Simulation, Tricks of the Trade|

Transitions of Care: Top 10 things admitting providers wish we did for older adults

“Transitions of care” has become a hot topic in the care of older adults. It is usually applied to the transition from the hospital to home or the hospital to a nursing facility. But what about the transition from the ED to an inpatient service? It turns out there are plenty of things we could be doing (or not doing) to help smooth that transition and improve patient care. Here are some thoughts from admitting physicians with geriatrics training.

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By Christina Shenvi, MD, PhD, MBA|2016-11-11T19:21:04-08:00Jun 2, 2014|Geriatrics|

Patients with fingertip injuries involving the nail bed typically present to the emergency department and require meticulous repair of the nail bed to prevent long-term cosmetic and functional disability. There are several methods to repair nail beds, typically involving absorbable suture, but maybe there is a faster way with similar cosmetic and functional outcomes.

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By Salim Rezaie, MD|2020-01-08T00:45:15-08:00May 26, 2014|Trauma, Tricks of the Trade|

Ondansetron: Has it reduced need for IV rehydration in vomiting kids?

A 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother states that the child has had fewer wet diapers today but has made tears when crying. On physical examination you note no rebound or guarding of the abdomen and determine that the child is moderately dehydrated. Your initial plan is to administer ondansetron and rehydrate the child orally. This is what you have been taught but is it actually efficacious? A just published 2014 JAMA Pediatrics article attempted to answer this question.

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By William Paolo, MD|2016-11-11T19:20:56-08:00May 22, 2014|Gastrointestinal, Pediatrics|

Piperacillin/Tazobactam and Risk of Acute Kidney Injury with Vancomycin

There are a few reasons why piperacillin/tazobactam (Zosyn) is not usually my first choice for a broad-spectrum gram-negative agent in the ED. First, at my institution, the Pseudomonas aeruginosa susceptibilities to pip-tazo are lower than that for cefepime. Second, pip-tazo does not have great CNS penetration, especially compared to ceftriaxone, cefepime, or even meropenem. Third, do we really need the anaerobic coverage that pip-tazo provides for every sick patient? Pip-tazo is great for empiric treatment of intra-abdominal and severe diabetic foot infections, but may not be needed for a hospital-acquired pneumonia. Fourth, with its frequent dosing (every 6 hours), too often the second dose is missed if the patient is still boarding in the ED.