You are treating a patient for diabetic ketoacidosis in the ED. Thing is, the patient isn't very ill and only has mild DKA (pH 7.25-7.3). Is starting a continuous insulin infusion and admitting the patient to an intensive care unit bed really the best use of resources? Read on for an alternative suggested regimen using subcutanoues doses of rapid acting insulin
For decades now, aggressive fluid replacement in pediatric DKA patients has been thought to contribute to cerebral edema and neurologic injury. This has resulted in a general policy of cautious fluid replacement with isotonic crystalloid, and perhaps even contributed to under-resuscitation of these patients. In this first large, randomized, prospective study to examine the role of type of fluid (0.9% NaCl vs 0.45% NaCl) and rate of administration, the hope was to detemine if type of fluid, rate of adminstration, or both were associated with cerebral edema and neurologic injury in this patient population. Read on for the key results of this practice changing paper!
You are resuscitating a septic patient in the emergency department and are about to click on the order for a fluid bolus. You are confronted with several options for isotonic crystalloid including normal saline, lactated ringer's, and something called "Plasma-Lyte A." A New England Journal article, hot off of the presses, will almost certainly influence this decision in the coming months and years. Read on for a synopsis of this certain-to-be controversial paper.
Ever wonder if all of your patients presenting with recent onset (<48 hrs) atrial fibrillation and a rapid ventricular response really need to be admitted? Is there evidence of a safe and effective treat and street algorithm that EM physicians can employ? Read on for a review of the Ottawa Aggressive Protocol for rapid afib that enables discharge of 97% of patients!
Looking for a high yield summary of post-cardiac arrest pearls? Look no further than this incredibly well acted video by the Cooper EM faculty recently presented by Dr. Brian Roberts, our very own NIH grant holding cardiac arrest researcher, at this year's NJ ACEP meeting in May
Can cheap, safe infusions of vitamins really succeed where so many hundreds of novel therapies have failed? The recent article in Chest by Dr. Paul Merik has taken the critical care world by storm, with reported mortality rates of 8.5% in patients treated with a simple vitamin C/thiamine cocktail (with none of the deaths directly attributable to sepsis). The skepticism and push-back have been nearly unprecedented, especially on #FOAMed. Whether you're a skeptic or an early adopter, you need to understand the basis for the debate by checking out this high-yield summary.
Ever wonder where the the current American Heart Association and American Stroke Association (AHA/ASA) guidelines for thrombolysis in acute ischemic stroke come from? Included is a summary of the landmark studies that have contributed to these recommendations (NINDS& ECASS III) as well as a review of IST-3.
In the era of Press Ganey, patient-oriented outcomes, hospital reimbursement, and physician compensation are all tied to patient satisfaction. Improving patient satisfaction is now a multi-billion dollar industry and encroaches on every aspect of healthcare, including residency training. How do doctors at the beginning of their careers affect patient satisfaction and impact Press Ganey Scores? This post reviews two studies shedding light on this issue.
Antibiotic use in patients with upper GI bleeding and concomitant liver cirrhosis is standard of care. However, have you ever wondered where that recommendation comes from and what exactly the benefits are?