EM/IM Sessions

EM/IM Sessions: VANISH Trial

Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Gordon, AC, et al. JAMA 2016 [paper] Why I chose this article The kidney is painfully fragile, often one of the first organs to fail in septic shock. According to the last several iterations of the Surviving Sepsis Campaign Guidelines,

EM/IM Sessions

EM/IM Sessions: High-Sensitivity Troponin T

Mokhtari A, Lindahl B, Smith JG, Holzmann MJ, Khoshnood A, Ekelund U. Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events. Ann Emerg Med. 2016;68(6):649-658.e3.  [paper] Why I chose this article  High-sensitivity cardiac troponin T (hs-cTnT) is a relatively new biomarker assay and

EM/IM Sessions

EM/IM Sessions: Assessing Fluid Responsiveness

Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?. JAMA. 2016;316(12):1298-1309. [paper] Why I chose this article We ask this question for every critically ill patient who remains hypotensive after what we believe is adequate fluid resuscitation. Knowing techniques to reassess these

EM/IM Sessions

EM/IM Sessions: ED Management of Febrile Neutropenia

ED Management of Patients with Febrile Neutropenia: Guideline Concordant or Overly Aggressive? Baugh CW, Wang TJ, Caterino JM, et al.  Academic Emergency Medicine. 2017;24(1):83-91 [paper] Why I chose this article? It’s always interesting to find something that is practice changing, reasonable, and not commonly done. This fits the bill. I was always taught to admit febrile

Inconceivable!

Inconceivable: Urinary Tract Infection

Chapter 11 – “Urinary Tract Infection” Welcome to the eleventh installment of “Inconceivable: medical terms that don’t mean what you think they mean.” You are taking care of an alert and oriented 80-year-old woman who presented to your ED from an assisted living facility. She reports a few days of weakness and poor appetite, but

EM/IM Sessions

Journal Club: Limited English Proficiency and ED Revisits

The Association between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 Hours. Ngai, Ka Ming et al., Annals of Emergency Medicine. August 2016: 68(3), 213 – 219 [paper] Why I chose this article? I was excited to stumble across it in Annals as I have an interest in evaluating the quality of care we provide

EM/IM Sessions

Journal Club: Procainamide vs Amiodarone for Stable VT

Randomized comparison of intravenous procainamide vs intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia:  The PROCAMIO study.  Ortiz et al., 2016 European Heart Journal [paper] Why I chose this article? The ACLS guidelines are quite specific on how to approach unstable conditions such as cardiac arrest.  They become much more vague and

Inconceivable!

Inconceivable: Rule Out

Chapter 10 – “Rule Out” Welcome to the tenth installment of “Inconceivable: medical terms that don’t mean what you think they mean.” You are evaluating a young, healthy woman on OCP who presents to the ED for pleuritic chest pain. Her chest x-ray, EKG, and labs are all normal. You document that her d-dimer was

EM/IM Sessions

Journal Club: Medical Error–The Third Leading Cause of Death in the US

Makary, Martin A., and Michael Daniel. “Medical Error Third Leading Cause of Death in the US.” Bmj 353 (2016): I2139. Print. PMID: 27143499 Wheww.  That’s quite the title. 3rd leading cause of death?? Really? Background: The CDC puts together their list of most common causes of death and this determines health policy. Money and awareness is

Inconceivable!

Inconceivable: Liver Function Tests

Chapter 9 – “Liver Function Tests” Welcome to the ninth installment of “Inconceivable: medical terms that don’t mean what you think they mean.” You are evaluating a patient presenting to the ED with right upper quadrant pain. Her laboratory testing reveals an elevated AST and ALT and her focused ultrasound shows shadowing gallstones and a