Feature Film: Strep Throat - To Treat or Not to Treat? That is the question...

Feature Film:  Strep Throat - To Treat or Not to Treat?  That is the question...

Our very own Irish George Clooney shares some pediatric pearls as he discusses the pros and cons of testing for and treating streptococcal pharyngitis including: using the centor criteria in children, test characteristics of the rapid antigen detection test, risks, complications and potential benefits of treating versus not treating and how to discuss these issues with parents. 

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Journal Club July 2017 - Risk Stratification of Acute Heart Failure

Journal Club July 2017 - Risk Stratification of Acute Heart Failure

With nearly 1 million US emergency department (ED) visits attributed to acute heart failure (AHF) annually, heart failure is a serious illness frequently managed by emergency physicians. More than 80% of visits result in hospital admission, and readmission rates may range from 30-60% within 3 to 6 months of initial discharge. ED visits related to AHF are expected to continue to rise with the aging population and improved survival rates in patients with chronic heart failure and acute coronary syndromes. One critical issue facing emergency physicians caring for AHF patients is deciding upon disposition: admission (with or without monitoring) or discharge (with or without early follow-up). Consensus guidelines are available to support decision-making around diagnosis and treatment; however, no current guidelines provide an evidence-based approach to disposition. For this month’s journal club, we reviewed three papers examining decision aids developed to assist emergency physicians in determining risk in AHF patients.

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Not Another Patient with Dizziness! - Evidence Based Pearls for Your Practice

Not Another Patient with Dizziness! - Evidence Based Pearls for Your Practice

Dizziness accounts for 4-5% of all emergency department (ED) chief complaints and 26% of ED patients endorse dizziness in their review of systems.  Although most presentations for dizziness are benign, nearly 200,000 strokes present with dizziness each year in the United States (Edlow et al. 2008).   Misdiagnosis of vertebrobasilar strokes is common, as symptoms may be minimal and patients often change how they characterize their symptoms.  In the video below, Dr. Siket covers a systematic and evidence based approach to guide your workup of this all too common patient.  

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Bud's Common and Simples - Intra-nasal Foreign Bodies

Bud's Common and Simples - Intra-nasal Foreign Bodies

You stuck what where?!?!   Dr. George "Bud" Higgins shares with us some tricks of the trade regarding evaluating and removing intra-nasal foreign bodies. He discusses some well known maneuvers ("parent's kiss," passing a foley catheter, bayonette forceps) and a more novel approach using intranasal positive pressure gas flow.

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Journal Club May 2017 - Suicide Risk Assessment

Journal Club May 2017 - Suicide Risk Assessment

Emergency physicians regularly see psychiatric patients who are having suicidal thoughts or engage in non-suicidal self-injurious (NSSI) behavior. In addition to working these patients up medically, it is part of our job to determine who needs emergent evaluation by a psychiatric provider and who is safe for discharge. This is a very important decision, as we do not want to send high risk patients home and keep low risk patients for extended periods of time while they await their evaluation. Balancing this can be difficult - oftentimes it is not obvious where a patient falls on this spectrum. We are taught various decision aids in medical school to help us risk stratify these patients - but how do they perform on emergency department patients? For this month's journal club, we looked at three papers that examine three different decision aids to help elucidate this issue.

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Bud's Common and Simples - Avulsed Teeth

Bud's Common and Simples - Avulsed Teeth

Dr. George "Bud" Higgins shares with us some tricks of the trade regarding evaluating and reimplanting avulsed teeth.  He answers four key clinical questions for us: 1) How do you classify dental injuries?  2)  How do you know whether or not the avulsed tooth is a primary tooth?  3) When should you consider reimplanting avulsed teeth? 4) How do you reimplant and stabilize an avulsed tooth until the patient can follow up with a dentist? 

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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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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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