According to recent studies, atraumatic needles (ATN) reduce the rate of post-dural puncture headache (PDPH) when compared to traumatic needles (TN – or bevel-tip needles such as Quincke needles) (27% vs 60%).  Also, the mean duration of PDPH from ATN…
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In recent years, the dogma regarding large-volume crystalloid resuscitation in trauma patients has changed, with increased emphasis on including plasma and platelets in addition to red blood cells in the immediate resuscitation protocol. The long-awaited PROPPR trial compared the safety and…
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Diagnostic lumbar punctures aid in the diagnosis of infections and diseases of the central nervous system. Life-threatening events from lumbar punctures are rare, but post–lumbar (dural) puncture headaches (PDPH) occur in 1% to 36% of patients, depending on the needle…
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Tranexamic acid (TXA) has been shown to decrease deaths from acute severe bleeding. To determine if time to treatment is associated with the effectiveness of TXA, these authors conducted a systematic review and only two trials met their criteria: the…
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There have been a few studies that have demonstrated that bedside ultrasound has a high sensitivity and specificity for fracture diagnosis. Researchers in Italy compared the accuracy of US to that of plain radiography (the gold standard) in 204 children…
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Choosing Wisely is an initiative by the American Board of Internal Medicine that solicits evidence-based recommendations by other specialty associations to identify tests or procedures in their field which are unnecessary.  The following are a set of five recommendations that…
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One of the more common presenting complaints to an ED is the adult presenting with chest pain.  In addition, one of the most common reasons for admission to a hospitalist service is the “Chest pain rule out MI” admitting diagnosis.…
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Key Recommendations 1). Initial evaluation Conduct physical exam, history (with careful attention to factors in Tables 1 & 2) and resting electrocardiogram (ECG) to identify a possible cause (see Tables 2 & 3). 2). Disposition from the emergency department (ED)…
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United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends the following as guidelines for imaging and transfusion in trauma: Key Recommendations Use CT early and liberally in adults with major trauma, even omitting plain films and the focused…
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The majority of intoxicated patients with a possible cervical spine injury remain in a cervical collar or undergo magnetic resonance imaging (MRI). This approach is preferred since computed tomography (CT) exams alone are insensitive for detecting ligamentous injuries. A study…
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Traumatic lumbar puncture (LP) is fairly common and occurs when the needle causes bleeding into the subarachnoid space. Introduction of peripheral red blood cells (RBCs) in cerebrospinal fluid (CSF) increases CSF protein levels, thereby complicating diagnosis of bacterial meningitis. This…
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This meta-analysis examined 58 prospective ED studies that involved diagnostic test accuracy among patients with suspected Non-ST elevation ACS. The meta-analysis found that the following clinical findings predicted excess ACS risk in patients presenting with chest pain: hypotension (systolic blood…
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This population-based cohort study between 2000 and 2012 from the UK’s Health Improvement Network database compared diagnoses between 275,000 adults who had been prescribed corticosteroids and 626,000 who had not been prescribed corticosteroids.  The query was whether corticosteroid recipients had…
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A recent meta-analysis of 13 studies that were investigating needle decompression compared data of sample size, mean chest wall thickness, and decompression success rates. The meta-analysis concluded that the needle decompression catheter should be at least 6.5 cm in length…
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Target Audience: Emergency clinicians Background: A multidisciplinary group of emergency physicians, radiologists, cardiologists, and others has developed appropriateness criteria for the use of imaging to help inform clinicians for four clinical scenarios presenting as chest pain in the ED. Key…
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