TamingtheSRU

Pain from rib fractures can be severely limiting in the acute setting. In this recap from our most recent Journal Club, Dr Olivia Gobble leads us through a paper looking at the effectiveness of Serratus Anterior Plane Blocks for treating pain from rib fractures in the Emergency Department.

Ultrasound is an increasingly ubiquitous tool to augment the physical exam in the Emergency Department. Dr Jazmyn Shaw walks us through a paper that looks at whether or not US is a useful adjunct to physical exam for the diagnosis of shoulder dislocation in the Emergency Department

Dr Casey Glenn walks through a study analyzing the 'lever test' for the diagnosis of ACL tears in the acute setting. Given significant swelling and pain the acute diagnosis of ligamentous injury can be both challenging and painful to patients. The lever test is a promising physical exam maneuver that may be more accurate and better tolerated that traditional exam maneuvers.

In this journal club podcast we break down 2 articles. Do we need to reduce doses of ketamine or etomidate in RSI to avoid post-intubation hypotension? Should video laryngoscopy fully and finally replace direct laryngoscopy in the ED?

Drs. Wilson and Arnold discuss the latest research that went into their development of a protocol for managing Acute Liver Failure

Dr Marlena Wosiski-Kuhn recaps a recent journal club covering the paper by Mahajan and colleagues: Serious Bacterial Infections in Young Febrile Infants with Positive Urinalysis Results.

Boarding of admitted patients in the ED and subsequent overcrowding of ED’s continues to plague hospitals in the United States and Internationally. The Covid-19 pandemic exacerbated an already growing problem regarding capacity management and patient flow. In this current climate, the Emergency Physician’s responsibilities continue to shift toward the front-end of the process, mainly patients waiting to be seen in the lobby. As such, identifying sick patients in a timely manner and utilizing additional resources to predict patients at risk of clinical deterioration will be paramount moving forward. This recap covers a paper that looks to see if EtCO2 can play a bigger and better role in the triage process

Dr Gillespie breaks down the recently published CLOVERS trial that looked into the early administration of vasopressors in sepsis

The management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction. The presence of HFrEF limits pharmacologic options for rate control. This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure

Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.