November's installment of the best of EM:RAP video discussing the article written by Stuart Swadron, MD in the November issue of EPMonthly.
Overdoses that cause bradycardia and hypotension. Don't miss this month's EM:RAP video by Mel Herbert, MD discussing the article The Brady Bunch
NEW VIDEO from Mel Herbert
Stroke Part 2: Cortical or Lacunar?
In a recent issue of EM:RAP, Dr Michael Weinstock and colleagues review
missed diagnoses, referencing a study by Kachalia et. al. They reviewed
122 closed malpractice claims from 4 liability insurers in which
patients had an alleged missed or delayed diagnosis in the ED. A total
of 79 claims (65%) involved ED diagnoses that harmed patients; 48% of
these were associated with serious harm and 39% resulted in death.
When evaluating children with CSF pleocytosis, bacterial meningitis is
the greatest concern, although most children end up having aseptic
meningitis. Therefore, these children are routinely admitted and
treated with broad spectrum antibiotics while awaiting final culture
Dr. Al Sacchetti weighs in on the issue of etomidate in sepsis and
reviews his recent debate with Dr. Ron Walls in the July issue of
annals of emergency medicine. Here’s a highlight. A single dose of
etomidate will eliminate the adrenal gland’s response to ACTH by
inhibition of 11-ß-hydroxylase leading to a depressed cortisol response.
Aortic dissection is a difficult diagnosis to make and has been dubbed
the “Great Masquerader” due to the myriad of possible presentations
including stroke, MI, abdominal pain, and lower extremity problems.
D-dimer may be useful as a screening test for dissection because of
reported sensitivities of >99% and negative predictive values
>99% across multiple studies.
A digest of Mel Herbert’s monthly audio CME series
edited by Chris Feier, MD