ACEP Clinical Policy Review: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department

ACEP Clinical Policy Review: 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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Vitamin C. . . The Holy Grail for Sepsis Treatment?

Vitamin C. . . The Holy Grail for Sepsis Treatment?

It is hard not to get excited about a new treatment for sepsis,  a disease that kills over 300,000 people each year in the US.  However, there have been so many false promises in the past, it is appropriate to be skeptical.  A recent study published online by the journal Chest is turning heads . . . not only because it appears extremely effective, but also because it is a simple, inexpensive treatment.  Could this be the silver bullet we have all been looking for?

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Get down that K-Hole! Ketamine for Control of the Agitated Adult Emergency Department Patient

Get down that K-Hole!  Ketamine for Control of the Agitated Adult Emergency Department Patient

Emergency physicians regularly encounter agitated patients that are a risk to both health care providers and themselves.  The onset of many traditional medications is relatively slow and often requires additional doses.  Although there haven’t been large numbers of studies, the use of ketamine to control the acutely agitated patient has been increasing both in the prehospital and ED settings. Its characteristics such as rapid onset, preservation of respiratory drive, and minimal hemodynamic effects make it potentially desirable as a first-dose control agent.  In this post, we walk through some of the literature on the use of ketamine for the acutely agitated patient.

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Vision Loss in the Emergency Department Patient

Vision Loss in the Emergency Department Patient

Hi guys!  Sorry it has been so long since our last post.  We were busy preparing for our Winter Symposium Conference last week in Sugarloaf, Maine. We had a fantastic line up of speakers and hope to share them with you over the coming months.  Here is a sample from one of our guest speakers, Jacob Avila, MD.  He spoke to us about vision loss in the emergency department patient. 

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Fluoroquinolones, Your Lawyer and You

Fluoroquinolones, Your Lawyer and You

Fluoroquinolones are a widely used class of antibiotics that are effective in treating a wide variety of infections. Despite their popularity there is increasing concern regarding the potential complications associated with these agents. Here we discusses the current evidence regarding the risks associated with fluoroquinolone use.

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Grandma Is Stoned! - Unintended Emergency Department Patients after Marijuana Legalization

Grandma Is Stoned! - Unintended Emergency Department Patients after Marijuana Legalization

Currently, 25 states and Washington, DC have varying degrees of legalization of marijuana. Most are medical marijuana but some have legalized recreational marijuana. This has led to a rise in certain unexpected health concerns. With the reality of Maine legalizing recreational marijuana, we thought this was a good time to look at some of the early literature coming out of Colorado.  

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