ACEP CLINICAL POLICY - CRITICAL ISSUES IN THE EVALUATION AND MANAGEMENT OF ADULT PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE HEADACHE

ACEP CLINICAL POLICY - CRITICAL ISSUES IN THE EVALUATION AND MANAGEMENT OF ADULT PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE HEADACHE

While clinical policy does not necessarily establish a standard of care, it is important to know where your organization stands on key clinical questions.  This American College of Emergency Physicians clinical policy summary focuses on the evaluation and management of adult patients presenting to the emergency department with acute, nontraumatic headache.  It focuses on five critical questions: (1) Does a response to therapy predict the etiology of an acute headache? (2) Which patients with headache require neuroimaging in the Emergency Department? (3) Does lumbar puncture need to be routinely performed on ED patients being worked up for nontraumatic subarachnoid hemorrhage whose noncontrast brain computed tomography (CT) scans are interpreted as normal? (4) In which adult patients with a complaint of headache can a lumbar puncture be safely performed without a neuroimaging study? (5) Is there a need for further emergent diagnostic imaging in the patient with sudden-onset, severe headache who has negative findings in both CT and lumbar puncture? 

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Can I Really Send that PE home?

Can I Really Send that PE home?

With the advancement of CT imaging, emergency physicians are diagnosing a wider spectrum of pulmonary embolism in the emergency department - from the "saddle embolus" to the small subsegmental filling defect.  With this spectrum of radiologic diagnoses also comes a spectrum of clinical severity.  Are there any patients with PE that are safe for discharge?  Dr. Ali Raja (voted this year's best speaker at the 2017 Maine Medical Center Winter symposium) helps to clarify this clinical question. 

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Bud's Common and Simples - Fingernail Avulsion Repair

Bud's Common and Simples - Fingernail Avulsion Repair

Fingernail avulsions constitute a unique fingertip injury as they have the potential to result in long term nail deformity and impaired function if not repaired properly.  In order to treat these injuries effectively, the treating provider must understand the anatomy of the nail bed, nail root, and the intricacies of nail growth. In this brief video, Dr. George "Bud" Higgins shares with us how to assess and treat this injury to optimize our patient's chances for successful nail regrowth, function and cosmesis.

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A New Era of Opioid Prescribing in Maine

A New Era of Opioid Prescribing in Maine

Opioid overdose deaths have continued to climb over the past few years. This national trend is also being seen in Maine where it ranked #13 in terms of overdose deaths per 100,000 population (MMWR: Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015). In response to this trend, Maine has recently passed legislation controlling the prescription of opioids and benzodiazepines.  Here are are six provisions of the new law every prescribing physician should know. 

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Bud's Common and Simples - Superficial Laceration Repair of Thin and Fragile Skin Lacerations

Bud's Common and Simples - Superficial Laceration Repair of Thin and Fragile Skin Lacerations

As a person ages, their skin loses elasticity, firmness, and thickness.  All these factors make thin and frail skin more likely to tear - and also more difficult to suture or staple.  Dr. George "Bud" Higgins demonstrates a unique technique to close these troublesome lacerations.

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Locating the Dislocation: Shoulder Ultrasonography

Locating the Dislocation:  Shoulder Ultrasonography

Still using propofol and brutacaine for shoulder dislocations?  There is a better way.  Bedside ultrasound for shoulder dislocations has been shown to reduce narcotic use, number of sedations, length of stay, cost, and radiation. Let's review the technique for shoulder ultrasonography and intra-articular injection of the glenohumeral joint. 

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ACEP clinical policy - Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department

ACEP clinical policy - Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department

As the emergency department has increasingly become more crowded with acute psychiatric emergencies, we thought it was timely to review the ACEP clinical policy for emergency department psychiatric patients.   It is hot off the press from January 2017 and updates the 2006 policy on the utility of routine labs, head imaging for new psychosis, risk-assessment tools for suicide, and use of ketamine for agitation.  

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Kayexalate - No Clear Benefit, Rare Harm

Kayexalate - No Clear Benefit, Rare Harm

The first patient on your overnight shift is a 57 yo female with end stage renal disease, presenting with weakness and confusion.  After a quick history, you discover she missed her dialysis two days ago because she "didn't feel well enough to go."  You quickly order an EKG and labs, and when they result, they confirm your suspicion - her potassium is 6.8  mEq/L.  After you give her calcium, insulin/dextrose and sodium bicarbonate to stabilize her, you consult your friendly neighborhood nephrologist for emergent dialysis. He tells you to give her some kayexalate and they will dialyze her in the morning. . . but will the kayexalate really buy enough time until tomorrow?

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Perron's Airway Pearls from AAEM 2017

Perron's Airway Pearls from AAEM 2017

The following airway pearls were gleaned from Dr. Mike Winters' lecture "Critical Care Quickies - Pearls for the Moribund Patient." This was presented at the pre-conference workshop "Resuscitation for Emergency Physicians" (23rd Annual Scientific Assembly of the American Academy of Emergency Medicine in Orlando, Fl).

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