Correct, we don’t have terlipressin in the US, yet… Hopefully, sometime in the not so far off future we’ll have the chance to play around with it. Essentially it’s a synthetic analog of vasopressin which we are more familiar with. There’s some written about its use in variceal bleeds and here is a cool little study from Egypt using it for refractory septic shock.
It’s difficult to miss a raging STEMI or a CVA with unilateral flaccid paralysis, but there are other, less-sexy diagnoses that we have the opportunity to make in the Emergency Department that can be as important and impactful to the patient’s health. Endophthalmitis is a difficult word to spell and equally as difficult to diagnose if you’re not …
In the past, vitamin K and FFP were the mainstays of reversing warfarin, but now we have fancy new drugs like four-factor prothrombin complex concentrate (4F-PCCs). 4F-PCCs can rapidly reverse the INR of warfarin induced coagulopathy with less volume and quicker than FFP. Many of the dosing regimens base the dose on the patient’s presenting …
Lower abdominal pain in women can be challenging diagnostic dilemma in the Emergency Department. We had a case of a 50-year-old woman that had been previously seen by her PMD 3 days prior and diagnosed with a “small kidney stone” without any imaging, but did get the ever-reliable percocet prescription. Needless to say, she came …
There was a case report published in the Western Journal of Emergency Medicine last year about interposed abdominal compression CPR (IAC-CPR). Personally, I’ve never heard anything of the sort and had to take a deeper look into it. Essentially, you need two people to do compressions, one for the chest and one for the abdomen. …
Newer second generation sulfonylureas are used extensively for treating type-2 diabetes mellitus (i.e. glyburide, glipizide, glimepiride and gliclazide). They are rapidly absorbed and reach peak plasma concentration typically within 2-4 hours; and have a duration of action up to 24 hours long. In 2010, the American Association of Poison Control centers reported nearly 4,000 cases …
Kids eat up your money in more ways than one. Some may eat it up in the form of $50,000 a year in college tuition and some eat it up as a meal. For coins that get stuck in the esophagus the American Society for Gastrointestinal Endoscopy recommends watching asymptomatic patients for a period of …
I recently gave an “ID Updates” lecture at AAEM’s Scientific Assembly in Las Vegas, February 2016. Here are the top 10 pearls from my lecture. Some may be review, some more cutting edge. Enjoy!
Dr. Rory Spiegel, from EMNerd, wrote a recent piece in Clinical and Experimental Emergency Medicine about how our undying love for left ventricular function in shock patients is perhaps overdoing it and the focus should rather be on the venous return.
Always screen patient for an Afferent Pupillary Defect (APD)! A negative Seidel Test does not rule out a Globe rupture Avoid NSAIDS and aspirin in Hyphemas and Globe Rupture CT Scan of the Orbit is only 56-68% sensitive for identifying a Globe Rupture, so don’t solely rely on it for the diagnosis! Order a Sickle …
ER physicians diagnose CHF often and actually very well on clinical grounds at the bedside. So why are we ordering BNP’s when we already know the diagnosis? The evidence clearly states in which situations the BNP will not help you. Check out the proposed algorithm recently published in EM Resident and let’s put the evidence …
We are hosting our 8th Annual Emergency Medicine Symposium on May 4, 2016 at the Passaic County Public Safety Academy in Wayne, NJ. This year we are fortunate enough to have Dr. Kevin Klauer…
On March 28, 2016 St. Joe’s announced the ALTO (Alternatives to Opiates) program in front of a Legislative Summit held here at St. Joe’s. This event was attended by U.S. Senators Bob Menendez, Cory Booker…