TamingtheSRU

Pyelonephritis is a commonly treated diagnosis in the emergency department. With resistance rates climbing to the first-line recommended fluoroquinolones and Bactrim, are other antibiotics appropriate in treating pyelonephritis? Join Dr Gabor as she discusses this article and its treatment recommendations for outpatient pyelonephritis with cephalosporins and how it compares to treatment with the more traditional fluoroquinolones / bactrim route.

Septic shock remains a leading cause of pediatric mortality, but the choice of first-line vasoactive agent has long been debated. Dr Newton, a PGY-3, discusses this single-center retrospective cohort study comparing epinephrine and norepinephrine as initial infusions in children with septic shock. While the primary kidney outcome (MAKE30) showed no difference, epinephrine was linked to higher 30-day mortality in propensity-matched analysis. The findings are hypothesis-generating and highlight the need for prospective pediatric trials.

In the ED, your words can be as powerful as your meds. In this episode, PGY-3 Dr Kotel unpacks the science of placebo and nocebo, showing how communication shapes patient outcomes—and how small shifts in framing, empathy, and reassurance can turn talk into treatment.

Lung-protective ventilation (LPV), characterized by low tidal volumes and appropriate PEEP, is a cornerstone in managing patients with acute respiratory distress syndrome (ARDS). However, its application in patients with severe acute brain injury raises concerns. The potential for lung protective ventilation to increase intracranial pressure due to hypercapnia and elevated PEEP levels necessitates a closer examination of its safety and efficacy in this unique patient population.

Many clinical decision rules exclude elderly patients from the derivation cohorts. So the question remains unanswered do all elderly patients need cervical spine CTs in the setting of trauma? What if they have no symptoms? This recap of a journal club article explores the incidence of significant cervical spine fractures in elderly patients.

It is well known that ultrasound has exploded in its application in both diagnostics and procedures and has ultimately revolutionized the way we practice medicine. With its growing use, more and more providers are comfortable using ultrasound for both identification of anatomy/pathology and to guide procedures that were previously only done with landmarks. While having the skills to perform landmark guided procedures is incredibly important, there is much value in being able to visually confirm anatomy to avoid procedure complications, especially when landmarks are difficult to palpate / identify in certain individuals. This recap of a recent journal club article covers a paper looking into the use of POCUS to help perform cricothyrotomy.

More than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In this breakdown of a Journal Club article, Dr de Castro will cover a recent paper comparing NIPPV to oxygen mask only during preoxygenation for intubation.

Severe trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxemia. Emerging studies in the intensive care unit (ICU) setting suggest that liberal supplemental oxygen therapy and hyperoxemia is associated with increased mortality. Limited evidence in the trauma population suggests similar outcomes.

We know that the d-dimer can be a helpful test for patients who have a low pre-test probability of pulmonary embolism. But can the test be pushed into use for higher risk patients? Will it still have useful negative predictive value or will we risk missing too many PEs?

Can a nitro slurry help with food bolus impaction? Glucagon and effervescent beverages have limited evidence for benefit. Can an old drug used in a new way help these patients?