Journal Club February 2018 - Contrast-Associated Nephropathy. The Risk is …. Well, Maybe not as High as We Thought

Journal Club February 2018 - Contrast-Associated Nephropathy.  The Risk is …. Well, Maybe not as High as We Thought

Computed tomography (CT) is a commonly used imaging modality in the US. In 2013, greater than 74 million CT scans were ordered.  Although recently there has been a decrease in the need for contrast for certain diagnostic needs, contrast remains very important in the diagnosis of pulmonary embolus, aortic pathology, infectious processes, and other soft-tissue pathology. Acute kidney injury (AKI) has been a concern for many years and the teaching has been that contrast can increase the risk of acute kidney injury.  Recent literature has addressed this issue and this month’s journal club offers a synopsis of these articles.  

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Difficult Discussions - Death notification and End of Life Care

Difficult Discussions - Death notification and End of Life Care

Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century.  The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools.  In part 2 of "difficult discussions", we share our approach for two difficult patient discussions - death notification and end of life care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.

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Difficult Discussions - Medical Error Disclosure and Refusal of Medical Care

Difficult Discussions - Medical Error Disclosure and Refusal of Medical Care

Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century.  The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools.  In part 1 of "difficult discussions," we share our approach for two difficult patient discussions - medical error and refusal of medical care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.

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Combating the Crisis - Not Your Osler's Endocarditis Anymore

Combating the Crisis - Not Your Osler's Endocarditis Anymore

IV drug use (IVDU) is on the rise, along with those diseases which occur from its use (osteomyelitis, septic arthritis, endocarditis, skin and soft tissue infections, spinal epidural abscess).  Until we can turn the tide of the opiate wave, we must be able to diagnose and treat the diseases that occur from IVDU. We are excited to introduce a new series of educational posts dedicated to helping the emergency provider care for patient with opiate addiction. In today's inaugural post we review the contemporary epidemiology of infective endocarditis and its association with IVDU.

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Feature Film - Wound Care Pitfalls in the Emergency Department

Feature Film - Wound Care Pitfalls in the Emergency Department

Matthew Delaney is an emergency physician who also helps run a wound care clinic.  With these dual roles, he has gained a unique perspective on both acute and chronic wounds that present to the emergency department.  In this feature film, he discusses some pearls and pitfalls of wound care in the emergency department. 

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So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

In the United States an estimated 300,000 sports-related concussions occur annually. Many of these are young athletes who are referred to the emergency department for evaluation. While there are robust clinical decision aids to clarify the need for a CT brain, the literature around concussions is a bit murkier. Recently, athletes who sustained a concussion were recommended to avoid exercise and vigorous cognitive activity until their symptoms resolved entirely. Several studies over the last several years have challenged these recommendations. Dr. William Meehan is the director for the Micheli Center for Sports Injury Prevention. We were fortunate to “pick his brain” regarding questions we are often asked by the parents of the young athlete . . . when can their child return to play? When can they return to their full course work at school?

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Journal Club January 2018 - Cervical Spine Fractures in the Elderly

 Journal Club January 2018 - Cervical Spine Fractures in the Elderly

Geriatric patients (> age 65) account for almost 1 in 5 of all cervical spine fractures, with 50% of cervical spine fractures occurring at the C1/C2 level.  Recent literature has questioned whether these clinical decision rules may be applied in the geriatric population, where over half of identified cervical spine fractures result from ground level falls.  Furthermore the reliability of physical exam, specifically midline tenderness, has been questioned in elderly patients.  January's journal club examined three articles that addressed this specific population of blunt trauma patients at risk for cervical spine injury. 

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Feature Film - Could There Be Light At The End Of The Behavioral Health Tunnel?

Feature Film - Could There Be Light At The End Of The Behavioral Health Tunnel?

Tomorrow, countless acute mental health patients will present to their local emergency department asking for help.  Our typical response?  Detain them for days until definitive resources are available.  Ironic for a specialty whose defining characteristic is timely diagnosis and treatment.  Door to balloon time for STEMI?   t-PA for stroke within the window?  Most emergency departments have complex operations, funding and resources to meet these goals.  How about a door to psychiatric bed time?  Not so much.  Sadly, the behavioral health care crisis in this country is only getting worse. While the demands on emergency providers to treat these patients continues to rise, resources continue to decline.  In this feature film, Dr. Kivela, current ACEP president, proposes some novel solutions to improve the care, cost and boarding times for this vulnerable population.  

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Journal Club November 2017 - Large Vessel Strokes

Journal Club November 2017 - Large Vessel Strokes

Ischemic stroke is one of the most frequently encountered neurologic emergencies. It can be a truly debilitating diagnosis, and yet classically, there has only been one treatment available for small and large vessel occlusions alike– tPA. Now, with the widespread availability of CT angiography and the advent and maturation of interventional techniques such as mechanical thrombectomy, the management of large vessel occlusion (LVO) strokes is rapidly evolving and is increasingly distinct from the management of other strokes. This is truly an exciting time in stroke care, so for this month’s journal club we focused on three questions relevant to the emergency provider:  1) What is the utility of prehospital clinical scales for rapidly identifying LVO strokes? 2) Should patients with suspected LVO be taken to the nearest stroke center or bypass smaller hospitals to reach a comprehensive stroke center?  3)  How effective is mechanical thrombectomy vs. tPA alone?

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