The Biliary Tree of Life: A review of common gallbladder and biliary diseases in the ED

Gallstone diseases are common and can lead to various intraabdominal emergencies. Gallstones are found in approximately 6% of men and 9% of women in the United States [1]. Epidemiological studies in Scandinavia reported even higher prevalence, finding 13-18% of men and 15-25% of women had gallstones [2]. Common risk factors for developing gallstones include [3]: Female Obesity Rapid /cyclic weight […]

Hydrocortisone plus Fludrocortisone for Adults with Septic Shock

Journal Club Summary Methodology: 3/5 Usefulness: 3.5/5 Annane D, et al. N Engl J Med. 2018 Mar 1;378(9):809-818.  Editorial: A Role for Hydrocortisone Therapy in Septic Shock? Question and Methods: Large multi-center, double-blinded, randomized-controlled trial comparing effects of steroids (fludrocortisone + hydrocortisone) to placebo on 90-day mortality of ICU patients in septic shock on vasopressors for at least 6 hours. Findings: […]

Echoes: Taking Your POCUS Game to the Next Level

Point of Care Ultrasound (POCUS) is becoming increasingly prevalent in Emergency Departments (EDs) for diagnostic, procedural, and management purposes. In this post, we will examine some less known, but extremely useful, indications for POCUS. For further information, please visit our POCUS archives and see Dr. Rajiv Thavanathan’s previous Grand Rounds post. These archives include posts highlighting the role of POCUS […]

Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial.

Journal Club Methodology Score: 4/5 Usefulness Score: 3/5 Sprigg N, et al. Lancet. 2018 May 26;391(10135):2107-2115 Question and Methods: Multicenter, double-blinded, randomized, placebo-controlled trial comparing if IV TXA vs placebo, given within 8h of spontaneous (non-traumatic) ICH onset, decreased death or dependence at 90 days. Findings: No difference in 90d dependence or death [Ordinal OR 0·88 (0·76 to 1·03) p=0.11]. […]

Mechanical CPR: Past, Current, and Future

Mechanical CPR is a technology whereby a machine performs chest compressions in place of a human provider. These devices are becoming increasingly prevalent in the prehospital and in-hospital arenas, and it is inevitable that healthcare providers will interact with them in some capacity. Given the variable evidence in the literature, the indications for when to apply these devices is not […]

Damage Control Resuscitation (DCR) – A Summary of the Joint Trauma System Clinical Practice Guideline

Hemorrhage is the leading cause of preventable death on the battlefield. Damage Control Resuscitation (DCR) works synergistically with Damage Control Surgery (DCS) and prioritizes non-surgical interventions that reduce morbidity and mortality due to trauma and hemorrhage. DCR aims to restore homeostasis and prevent or mitigate tissue hypoxia and coagulopathy. This is accomplished through aggressive hemorrhage control and blood transfusion with […]