Oh Me Nerves! A Neurology Medley

Here we seek to review relatively common neurology presentations and some controversies surrounding their management. See our other ED-Neurology Reviews here including migraine therapies and stroke evidence.  To include Myasthenia Gravis, Guillian Barre Syndrome, and Multiple Sclerosis in the ED. For each we will review: A brief overview of pathophysiology Clinical presentation and work-up Important management considerations for the ED […]

Responsible Antibiotic Use in the Emergency Department

  Part 1: Concerns with Antibiotic Overuse Three of the most common antibiotic-related unwanted effects seen the ED include: Their toxic effects Selection of pathogenic bacteria Increasing antibiotic resistance The Magnitude of Antibiotic-Related Toxic Effects A data-set analysis of almost 110,000 residents in 67 Ontario nursing homes demonstrated that there was a 24% increased risk of antibiotic-related adverse effects in […]

Video versus Direct Laryngoscopy: Calling for Truce in the Arms Race

    Airway management in the Emergency Department (ED) is challenging. Given the critically ill and physiologically unstable patients, complicated by c-spine collars, distorted anatomy, and airway contamination – the stakes are high. Recent evidence draws attention to an adverse event rate of approximately 8-12% in the ED.1–3 Even more daunting is that with successive attempts, the complication rate rises […]

Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 3/5 Grool AM, et al. JAMA. 2016 Dec 20;316(23):2504-2514. EDITORIAL: Physical Activity or Rest After Concussion in Youth: Questions About Timing and Potential Benefit. Chrisman SP JAMA. 2016 Dec 20;316(23):2491-2492. doi: 10.1001/jama.2016.17562. This prospective multicenter cohort study found a possible relation between early physical activity (<7 days) and a lower PPCS at 28 days […]

Time to Treatment and Mortality during Mandated Emergency Care for Sepsis

Journal Club Summary Seymour CW, et al. Journal N Engl J Med. 2017 Jun 8;376(23):2235-2244. EDITORIAL: State Sepsis Mandates – A New Era for Regulation of Hospital Quality. Hershey TB, et al. N Engl J Med. 2017 May 21. Methodology Score:  3.5/5 Usefulness Score:  3/5 This large retrospective review of observational data from 185 hospitals (49,331 patients) with severe sepsis or […]

Approach to the Physiologically Difficult Airway

Physiologically difficult airway: airway management in the critically ill patient, whose underlying physiology puts them at higher risk of cardiovascular collapse with intubation and conversion to positive pressure ventilation. This is important for in the Emergency Department as airway management is fundamental in the care of critically ill patients, but is not without risk – in fact it carries among […]

Getting it ‘Right’: Pulmonary Hypertension in the ED

Describe the pathophysiology of Pulmonary Hypertension (PH), and how it can be dangerous Who to suspect and workup for PH in the ED Describe the POCUS findings in PH Describe the management of these patients and how to avoid causing harm Physiology Definition Pulmonary hypertension (PH) is defined as a pulmonary artery mean pressure >25 mmHg by right heart catheterization […]