This week we discuss some pearls from the 14th All NYC EM Conference.

All NYC EM Conference

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Core EM: Episode 77.0 – Give TXA Now!

This week we dive into rhinosinusitis exploring the recommendations of who needs antibiotics and who doesn't.

Take Home Points

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Core EM: Acute Rhinosinusitis

TheNNT.com: Antibiotics for Clinically Diagnosed Acute Sinusitis in Adults

TheNNT.com: Antibiotics for Radiologically-Diagnosed Acute Maxillary Sinusitis

This week we review the presentation, examination and diagnosis of testicular torsion.

Take Home Points

Show Notes

Core EM: Testicular Torsion

Ben-Israel T et al. Clinical predictors for testicular torsion as seen in the pediatric ED. Am J Emerg Med 2010; 28:786-789.

Sidler D et al. A 25-year review of the acute scrotum in children. S Afr Med J. 1997;87(12) 1696-8. PMID:

Mellick LB. Torsion of the testicle: It is time to stopping tossing the dice. Pediatric Emer Care 2012; 28: 80-6. PMID:

Ban KM, Easter JS: Selected Urologic Problems; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 99: p 1326-1356.

This week we discuss more pearls from our morning report conference on APE, SAH and caustic ingestions.

Take Home Points

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Core EM: Acute Pulmonary Edema

EMCrit: Sympathetic Crashing Acute Pulmonary Edema (SCAPE)

EMCrit: Delayed Sequence Intubation

Core EM: Setting Up Non-Invasive Ventilation

The SGEM: Thunderstruck (Subarachnoid Hemorrhage)

Friedman BW. Managing Migraine. Ann Emerg Med 2017; 69(2): 202-7. PMID: 27510942

This week we discuss some recent publications relevant to EM: ADRENAL, Idarucizumab and Time to Furosemide.

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Core EM: Idarucizumab for Reversal of Dabigitran

Core EM: Idarucizumab for Reversal of Dabigitran II

First10EM: Idarucizumab: Plenty of Optimism, Not Enough Science

EM Lit of Note: The Door-to-Lasix Quality Measure

EMS MED: When It’s More Complicated Than A Tweet: Door-To-Furosemide And EMS

REBEL EM: Door to Furosemide (D2F) in Acute CHF . . . Really?

emDocs.net: Furosemide in the Treatment of Acute Pulmonary Edema

Core EM: Door-to-Furosemide Time

References

Pollack et al. Idarucizumab for dabigitran reversal – full cohort analysis. NEJM 2017; 377(5): 431-41. PMID: 28693366

Matsue Y et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized with Acute Heart Failure J Am Coll Cardiol 2017; 69(25): 3042-51. PMID: 28641794

This week we discuss the disutility of orthostatic vital signs as a diagnostic tool in patients with suspected volume loss.

Summary: Based on the limited available evidence, it’s unlikely orthostatic vital sign measurement can be used to determine which patients have volume loss and which do not. The baseline prevalence of orthostatic vital signs is common and patients will not always develop orthostatic vital signs in response to volume loss. Therefore, there will both be patients who are orthostatic by numbers without volume loss and there will be patients with volume loss who are not orthostatic by numbers. Symptoms, with the exception of inability to stand to have orthostatics performed, are not useful either.

Bottom Line: Based on the low overall sensitivity of orthostatic vital sign measurements, they should not be used to influence clinical decision making.

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REBEL EM: Orthostatic Hypotension in Volume Depletion

References:

Skinner JE et al. Orthostatic heart rate and blood pressure in adolescents: reference ranges. J Child Neuro 2010; 25(10): 1210-5. PMID: 20197269

Stewart JM. Transient orthostatic hypotension is common in adolescents. J Pediatr 2002; 140: 418-24. PMID: 12006955

Ooi WL et al. Patterns of orthostatic blood pressure change and the clinical correlates in a frail, elderly population. JAMA 1997; 277: 1299-1304. PMID: 9109468

Aronow WS et al. Prevalence of postural hypotension in elderly patients in a long-term health care facility. Am J Cardiology 1988; 62(4): 336-7. PMID: 3135742

McGee S et al. The rational clinical examination. Is this patient hypovolemic. JAMA 1999; 281(11): 1022-9. PMID: 10086438

Johnson DR et al. Dehydration and orthostatic vital signs in women with hyper emesis gravidarum. Acad Emerg Med 1995; 2(8): 692-7. PMID: 7584747

This week we welcome back Andy Little from Doctors Hospital in Columbus, Ohio to chat about ear foreign body removal.

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DiMuzio J, Deschler, DG. Emergency department management of foreign bodies of the external ear canal in children. Otol Neurotol. 2002; 23(4):473-5. PMID: 12170148

Leffler S et al. Chemical immobilization and killing of intra-aural roaches: an in-vitro comparative study. Ann Emerg Med. 1993; 22(12):1795-8. PMID: 8239097

ALiEM: Trick of the Trade: Ear Foreign Body Removal with Modified Suction Setup

This week we review pearls from the EEMCrit conference back in January 2018.

Show Notes

Core EM: Procainamide vs Amiodarone in Stable Wide QRS Tachydysrhythmias (PROCAMIO)

PulmCrit: Myth-Buesting: Lactated Ringers is Safe in Hyperkalemia, and Is Superior to NS

PulmCrit: BRASH Syndrome

This podcast discusses an 8 step process for building better presentations.

Resources:

P Cubed Presentations

Presentation Zen

Presentation Zen: Simple Ideas on Presentation Design and Delivery

Keynotable

This week we discuss some pearls and pitfalls when caring for HIV+ patients in the ED.

HIV Associated Infections Based on CD4 Count (cooperhealth.org)

Total Lymphocyte Count  = (% lymphocytes x WBC count)/100

Show Notes

REBEL EM: REBEL Cast Episode 1 – Total Lymphocyte Count as a Surrogate Marker for CD4 Count

LITFL: HIV and AIDS

References

Obirikorang C et al. Total Lymphocyte Count as a Surrogate Marker for CD4 Count in Resource-Limited. BMC Infectious Diseases Journal 2012; 12 (128): 1 – 5. PMID: 22676809