Tamingthesru
Stuck between a Rock and a Hard Place: Navigating Renal Colic Treatment
Renal colic is a common presenting symptom in the ED, with an estimated prevalence as high as 10-15% in the US. (1) It accounts for approximately 1% of all ED visits per year. (27) Most patients will pass these calculi spontaneously and do not require surgical intervention, therefore focus on pain relief is of utmost importance in the emergency department. (1) NSAIDs have shown to be as effective, if not more effective than opioids, making them a reliable first line agent. (4,5) Opioids still provide a viable option in those with kidney disease or gastric ulcer disease, however they may be best utilized as combination agents to decrease the need for rescue analgesia. There is weak evidence to support the use of IV acetaminophen, with high cost burden, limiting its utility. Additional agents such as ketamine, lidocaine and magnesium carry with them limited evidence and inconsistencies in the literature, limiting their use, with further studies required. Alpha blockers seem to provide a shorter duration to expulsion, fewer pain episodes, and less hospital admissions with surgical intervention, specifically with larger stones (>5mm).
Therapeutics: Agitation in the ED
Agitation? Second nature to most Emergency Physicians but an art as much of a science. The science lays the backbone of this art, however and that’s where Dr. Courtney Kein comes in. Click and join us on a dive into the literature of sedation of the agitated patient.
Open Breaks - Antibiotics for Open Fractures
Open fractures are a common pathology seen in emergency departments, especially in trauma centers. In open fractures, the skin barrier has been compromised, exposing sterile bone to the environment. Considered a true orthopedic emergency, these fractures have high morbidity due to osteomyelitis, with infection rates up to 55%. (1) Appropriate and timely intervention in the emergency department with proper antibiotic therapy, wound care, and early orthopedic surgery involvement dramatically reduces the risk of developing osteomyelitis. In this post we will discuss antibiotic recommendations for osteomyelitis prophylaxis for open fractures. Initial management of open fractures is discussed in another post.