Management of postpartum hemorrhage in the emergency department

Case

It has been a busy day in your emergency department. The precipitous delivery that occurred at triage was complicated by shoulder dystocia. Luckily you had some help, and one of your colleagues is managing the neonatal resuscitation. Nurses are starting to congratulate mom and pat you on the back, when a senior nurse points out that the patient looks pretty pale. You glance at the monitor and notice a heart rate of 145 and only then do you notice that she is bleeding… a lot…

Continue reading “Management of postpartum hemorrhage in the emergency department”

EBM Lecture Handout #1: PPIs for GI Bleeds

Should we be starting PPIs on undifferentiated upper GI bleed patients in the emergency department prior to endoscopy?

Continue reading “EBM Lecture Handout #1: PPIs for GI Bleeds”

EBM Lecture Handout #2: Topical Anaesthetics fo Corneal Abrasions

A summary of the evidence supporting the use of topical anesthetics for pain control in simple corneal abrasion after emergency department discharge

Your patient’s child poked him in the eye, and now he is in the most excruciating pain of his life. After a thorough eye exam, you determine he has a simple corneal abrasion. Your patient is ready for discharge, and has actually been pain free ever since you but 2 drops of tetracaine in the affected eye. “Hey, can you give me some of those amazing drops? They really worked!” You look down at this poor soul, and for some reason you say “no”.

Why don’t we use topical anesthetics for pain control in patients with simple corneal abrasions?

Continue reading “EBM Lecture Handout #2: Topical Anaesthetics fo Corneal Abrasions”

EBM Lecture Handout #3: Stress testing (part 1)

There are two handouts that cover the literature surrounding the use of exercise stress testing to risk stratify patients in the emergency department. For part one, I am posting, in its entirety, a critically appraised topic I did as a resident research project during my emergency medicine fellowship year. Part 2 can be found here.

Clinical Question

In emergency department chest pain patients with a normal electrocardiograms and negative cardiac biomarkers, can an exercise stress test predict short term risk for death or myocardial infarct? Continue reading “EBM Lecture Handout #3: Stress testing (part 1)”

EBM Lecture Handout #4: Stress Testing (part 2)

In addition to the critically appraised topic in part 1, here are some additional papers on stress testing worth knowing about. Continue reading “EBM Lecture Handout #4: Stress Testing (part 2)”

EBM Lecture Handout #5: Heparin in ACS

It is often good to review why we do what we do. Heparin is a therapy that is started multiple times every day in every emergency department in the world. It is our bread and butter. But what exactly does heparin do? Specifically:

What is the benefit for our patients of giving heparin in the setting of an acute coronary syndrome?

Continue reading “EBM Lecture Handout #5: Heparin in ACS”

EBM Lecture Handout #6: Salter Harris 1 Injuries

The traditional teaching about Salter-Harris 1 injuries goes something like this: Because the injury is directly to the growth plate, these injuries will be invisible on x-ray. In children, ligaments are stronger than bone, so if there is pain near a growth plate, we should assume that it is an injury to the bone not the ligament. Therefore, we should cast (or splint) all children with tenderness near the growth plate, regardless of x-ray findings. This myth is based on a few misunderstandings, which are outlined below.  Continue reading “EBM Lecture Handout #6: Salter Harris 1 Injuries”