TamingtheSRU

This months journal club focused on evidence supporting (or not supporting) three different entrenched practices in the ED. The authors discuss the use of lidocaine with epinephrine for digital blocks, use of beta blockers in cocaine associated chest pain, and discharging patients with corneal abrasions with tetracaine.

We take a dive into the literature looking at the treatment, evaluation, and disposition of patients with community acquired pneumonia. Is any one scoring system better than another? Can we predict which patients will have drug resistant pathogens? Can BNP replace PSI for predicting patient mortality?

We discuss several articles looking at the care of patients with heart related complaints. Does Magnesium have an adjunctive role for rate control in A fib with RVR? Can we not just treat most all A fib with RVR patients in an outpatient pathway? Does the HEART score perform as well 1 year out as it does at 30 days in terms of limiting health care utilization

We dive into the key defining characteristics to recognize cardiogenic shock with limited information available. We then review what key initial steps may help stabilize these often critical patients.

We discuss several articles pertaining to the use of antibiotics in the ED. Should we be ordering Vancomycin for patients likely to be discharged? Is the combo of Vancomycin and Pipercillin-Tazobactam nephrotoxic? Is it helpful to add Bactrim to Cephalexin for patients with cellulitis but no abscess?

Dr. LaFollette discussed the evidence based approach to cardiac arrest care with Dr. Joshua Gauger and Dr. Shaun Harty as the summarize and recap their quality improvement and knowledge translation project.

In this rundown of our most recent Journal Club, Drs Soria, Murphy, and Whitford cover 3 articles looking into how best to manage a patient's airway in cardiac arrest. Should we just bag all these patients or should we move to intubating quickly? How good are EGDs? Are they better than intubation? The discussion also turns to the results of an abstract presented at the most recent SAEM Academic Assembly which outlines the first randomized control trial looking into airway management in out of hospital cardiac arrest.

Drs Andrew Latimer and Adam Gottula cover the use of ultrasound in the helicopter EMS. They talk about the barriers to using the device in the field and the advantages to patient care.

The choice of resuscitative fluid for bleeding trauma patients is clear: blood is your go to. But what kind of blood product is best. Recently literature has suggested that the transfusion of blood components in a 1:1:1 ratio portended better outcomes. Most recently, based on some emerging military literature, it has been suggested that the transfusion of whole blood may result in improved outcomes and reduce overall transfusions. In this podcast, we will take a look at three articles that look into the feasibility of and benefits from the transfusion of whole blood.

Differing guidelines between European and US healthcare societies can make the administration of Rhogam in the ED a bit confusing. Dr. Gottula sits down with Afshin Taleghani, PharmD to demystify the indications for administration.