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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Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department

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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