5 Minute Journal: Smelling Salts not included

Dr. Harrison Pidgeon Background: We see nausea all the time in the Emergency Department (ED). Providers have different preferences on what agents they use as anti-emetics. But when put through the best evidence based tests (randomized controlled trials), ondansetron/Zofran, metoclopramide/Reglan, and prochlorperazine/Compazine fail to prove better than placebo for undifferentiated nausea. These agents are used

5 Minute Journal- PE YEARS

Author: Dr. Shivon Manchanda “Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism.” Background:  The diagnosis of PE can be challenging. We do not want to scan everyone, yet even with the creation of decision-making tools, our use of CTPA is going up, while our yield of actual PE is going down. And pregnancy makes

5 Minute Journal Club

Author: Dr. Tisma Background/Study Question How often do septic patients receive their second antibiotic dose later than they should? What are the risk factors for these delays? And do these delays affect patient outcomes? Leisman et. al. published a study in 2017 that examined these important inquiries. These questions are particularly interesting to me as

5 Minute Journal Club: Hypertension, Nosebleeds, and Vasoconstrictors walk into a bar

Author: Dr. Dennis McKinney Background: Epistaxis is one of the most common presenting chief complaints in the emergency department, accounting for about 1 in 200 visits. Different algorithmic approaches exist to address epistaxis, with application of intranasal vasoconstrictors usually existing somewhere in between empathetic counseling/clamping and a rhino rocket. Most intranasal vasoconstrictors have precautions against

5 min Journal Club: Hydrocortisone + Fludrocortisone for adults with septic shock

Author: Vanessa I. Petrak, M.D. Background: Septic Shock is a dysregulated host response to infection, resulting in life-threatening circulatory, cellular, and metabolic abnormalities. Sepsis is associated with a dysregulated response of the hypothalamic-pituitary-adrenal axis that may involve any of the steps from cortisol production to cortisol use by cells. Short term mortality is approximately 45-50%, and

5 minute Journal Club: shocking Norepi use

Author: Dr. Collin Wulff, DO Study Question: Does early low-dose norepinephrine improve shock control in those with sepsis with hypotension? Design: Mostly good buzzwords here; single center, randomized, double-blind, placebo controlled clinical trial, smallish study (310 total). The study group received a fairly low dose of norepi infusion (0.05 mcg/kg/min). The primary outcome was not

5 Minute Journal: Nec-Fasc fast!

Author: Dr. Jeny Tan-Creevy Background: Necrotizing soft tissue infections more commonly known as necrotizing fasciitis is a life-threatening diagnosis with a high risk for morbidity and mortality. Gold standard for diagnosis is surgical exploration, which unfortunately is difficult in the Emergency Department. The study is a meta-analysis to investigate the accuracy of physical examination, imaging, and