Transplant Medicine in the ED

Patients who receive solid organ or stem cell transplants are complex, but we see them frequently in the Emergency Department! This review summarizes the physiology of transplant and a few of the key issues to be aware of in these patients. Transplant by the numbers Locally, in Ottawa, there are approximately1: 100 renal transplants per year – the transplant clinic […]

Tricks of the Trach: Approach to Tracheostomy Patients in the Emergency Department

In this post, we will review the anatomy, essential history, and common presentations of tracheostomy patients in the ED, including obstruction, decannulation, bleeding, tracheal stenosis, and infection. Anatomy of a tracheostomy tube Outer cannula Sits directly in the tracheal stoma Proximal end designed to allow tube to be easily secured in place Distal end may or may not be cuffed […]

DEFUSE-3: Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging

Methodology: 3.5/5 Usefulness: 4/5 Albers GW, et al. N Engl J Med. 2018 Jan 24. Journal Club Bottom Line Question/Methods: This was a multicentre, prospective, randomized, open label, blinded outcome trial comparing thrombectomy + medical therapy vs medical therapy alone in patients with delayed presentation (6-16 hours) of proximal MCA & ICA strokes with a small infarct to penumbra ratio […]

Sweating the Small Stuff: An Evidence-Based Urgent Care Potpourri

Urgent care presents a specific set of challenging clinical questions for the emergency physician. Often, seemingly mundane presentations will leave us questioning whether or not we have managed a case appropriately. Our decision-making can be highly influenced by the long lasting effects of dogma, clinical anecdotes, or historical studies of limited methodological quality. In many cases, no evidence exists to […]

Sickle Cell in the ED: An Update

Sickle Cell Disease (SCD) is a complex medical entity, associated with significant morbidity and mortality. Patients with SCD suffer from acute and chronic pain, along with a seemingly endless list of additional complications (from hemolysis and sequestration, to aplastic crises and acute chest syndrome). The associated morbidity of SCD is apparent, but these patients also have an alarming decrease in […]

Back to Basics: Revisiting Common EM Controversies

In this post, we will explore the current literature regarding common EM controversies, covering the nature and prevalence of penicillin allergies, the management of skin and soft tissue infections, and the role of NSAIDs for acute pain. Penicillin allergies in the ED Penicillin (PCN) is a Beta-lactam antibiotic discovered in 1928. As of 2010, Beta-lactams (penicillins and cephalosporins) were the top […]

Selected Imaging Controversies in ED Trauma

Traumatic injuries are amongst the most common presentations for all emergency departments (ED).  In 2010, there were over 1 million patients in Canada who visited the ED for trauma, result in an cost of almost 9 billion dollars.1  Yet, in spite of their frequency, there remains a great deal of practice variation and uncertainty about the optimal imaging approach in […]

An Analysis of Paralysis: Neuromuscular blocking agents in the Emergency Department

In this post, we will discuss the use of neuromuscular blocking agents (NMBAs) for intubation in the Emergency Department; we will focus on considerations in predicted difficult airways (RSI vs. awake intubation), Rocuronium vs. Succinylcholine, and the indications for Sugammadex. This post will not cover laryngoscopy; although this was previously well covered by Dr. Peter Reardon’s previous Grand Rounds Summary […]

An Update: Rate Control in Atrial Fibrillation

In this post, we will discuss updates and controversies surrounding rate control in Afib, specifically we will: Review the new 2017 CAEP Afib best practices guidelines Review Tachycardia Induced Cardiomyopathy Review Afib and Type 2 ACS Discuss the identification and management of secondary Afib 2017 CAEP AAF Best Practices Guideline Update: Risk Stratification: Unstable AAF (Acute Afib) is very rare: […]