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Telling Tall Tales: Dogma in Emergency Medicine
In our training and education as Emergency Medicine providers, we often come to accept certain practice patterns as fact. When these established “facts” come along with fantastical clinical claims (don’t give your corneal abrasion patients tetracaine, it’ll melt their corneas; don’t use lido with epi for digital blocks, their finger will fall off; don’t use beta-blockers in patients on cocaine, their BP will skyrocket due to unopposed alpha-effects), we should probably look to question their supporting evidence.
Pneumonia Alphabet Soup
Pneumonia. It’s one of the first conditions we learn to diagnose as medical students. It was probably the cause of the first really sick, septic geriatric patient you saw in residency. Conversely you have also probably sent a fair share of patient’s home with an outpatient course of antibiotics and PCP follow-up. While determining the appropriate treatment and disposition for patients on the extreme ends of illness severity is quite straight forward; that pesky majority in the middle can be a conundrum at times. Who can go home? Who needs broad spectrum? Who needs step-down? Over the last two decades there has been a smorgasbord of pneumonia related acronyms used in clinical practice to predict severity, guide therapeutics and recommend disposition. During our most recent resident Journal Club, we took a look at a handful of the more familiar acronyms as well as some new ones coming down the pipeline.
A Weakness in the HEART?
In this month’s Journal Club Recap we take a look at some recently published literature about common heart related complaints in the ED. First, we look at the now nearly ubiquitously used HEART pathway. In a US population, do the benefits of decreased health care utilization sustain themselves to a year out of an index visit? Then we turn our attention to atrial fibrillation with RVR. Does the utility infielder of ED medications, Magnesium, actually help with more rapid rate control? And, should the results of a consensus panel sway us to treat A fib with RVR as an outpatient?