PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism
Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate has been the optimal treatment for sub-massive PE. The MOPETT Trial was published in January 2013 and although the patient population was small, it did show a huge benefit in pulmonary pressures at 28 months with fibrinolysis. The next study we have all been waiting for is the Pulmonary Embolism Thrombolysis (PEITHO) trial, which was just published yesterday in the NEJM, evaluating fibrinolysis for patients with intermediate-risk PE. [+]
Top 10 reasons NOT to order a CT scan for suspected renal colic
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 [+]
Article: Hypotonic maintenance IV fluids in pediatrics
A 6-month-old male presents to the emergency department with diarrhea and vomiting. Despite antiemetic therapy, the the child is unable to tolerate oral intake in the ED and so you opt to admit him to the hospital for IV fluids. The pediatric hospitalist requests that you write maintenance fluids prior to admission to the floor. Utilizing the 4-2-1 rule you calculate maintenance needs and choose D5 ½NS as your fluid. This is what you had been taught to utilize in children. It seems appropriate… but is it? [+]
Basics of Blogging at 2014 CORD Academic Assembly
Turns out New Orleans is a fantastic city, not just for the food and culture, but also as a setting for the 25th anniversary year of the Council of Residency Directors Academic Assembly conference (CORD). The ALiEM crew was on hand to help teach a pre-conference workshop called #DontGetLeftBehind: FOAMed and Social Media for EM Educators, dedicated to learning tricks of the trade of the different modalities of social media for medical education. Naturally we focused our section on blogging. Rather than let all that information go to waste, we have shared our work in this post in the true spirit of [+]
Beware of fluoroquinolones: You, your patient, and the FDA
Fluoroquinolones are a widely used class of antibiotic that are effective in treating a wide variety of infections. Despite their popularity there is increasing concern regarding to the potential complications associated with these agents. In 2008, the U.S. Food and Drug Administration (FDA) issued a black box warning involving fluoroquinolone use and an increased risk of tendon rupture. More recently in 2013 the FDA released another warning regarding the risk of peripheral neuropathy and required additional warnings to be added to the drug labels [1]. [+]
MEdIC Series: The Case of the Humorous Humerus – Expert Review and Curated Commentary
The Case of the Not-So-Humorous Humerus presented an attending faced with a patient complaint about a resident. This is a situation that all of us will almost certainly be faced with at one point or another and there is no easy way to address it. This month we asked you to tell us how you would approach this difficult conversation to successfully determine what the problem was and how it should be addressed. [+]
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 [+]
Uncomplicated Urinary Tract Infections in Older Adults: Diagnosis and Treatment (Part 2)
It seems like a simple enough question: How do you diagnose and treat uncomplicated urinary tract infections (UTIs) in older adults? The answer is: It depends. In Part 1 of this post we discussed the diagnosis of UTIs in cognitively intact older adults and those with underlying cognitive impairment. This post will discuss treatment options. UTIs are the most common bacterial infection diagnosed in older adults (age 65 and over).1 They are the most common reason for antibiotic use and account for 5% of ED visits in this population.2 Remember from part 1 that asymptomatic bacteriuria is very common in older adults, and does [+]
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? [+]
Conference Tweeting: Do not start tweet with @ symbol
In the last two years, live tweeting from medical and education conferences has become mainstream. What better way to stay up-to-date with what is being taught around the globe! Pioneers like Dr. David Marcus (@EMIMDoc) even archive all of the conferences with hashtags, Twitter handles, and topic focus on his EM IM Doc blog. [+]