Here is the first of many from Dr Dan Weston. He will be trawling the world of interesting FOAMem and taking us through what he sees as the belters! Here we go…
Papers
GCS….remember that!?
Calculating GCS is not terribly arduous, and yet it can still be done poorly, be time-consuming and require reference to charts, not ideal in a pre-hospital setting. It is unnecessarily complicated but remains mandatory in the assessment of patients.
This meta-analysis shows that GCS could effectively be replaced by mGCS (scored 0 – 2, 0 = 1-4 on the motor component of the total GCS (tGCS), 1 = 5 of the motor component of tGCS and 2 = 6 of the motor component of tGCS).
The NEWS (national early warning score) includes AVPU as part of its scoring rather than GCS and it seems that these simpler scores are just as useful as calculating the full GCS.
That old contrast argument, again!
An interesting paper looking at AKI following contrast in the ED. This adds to a growing body of evidence that indicates fears around contrast-induced nephropathy may be unfounded.
Inhale…inhale!!!
Asthma is a common presentation to the ED, both in adults and children. The mainstay of the guidelines in our trust are for inhaled beta 2 agonists and oral steroids for discharge. There is little consideration for the initiation of inhaled corticosteroid (ICS) therapy despite it being a part of chronic management. This paper looks at the initiation of an ICS at discharge from the ED and whether it is continued in the community and if it improves reported symptoms.
The authors conclude – ‘The intervention was associated with reduced reported symptoms but did not affect other asthma outcomes or primary care provider follow-up.’ This paper does not indicate a need for a change in practice and, although there was an association with an improvement in reported symptoms, this could possibly be confounded by the lack of blinding in the study.
Blogs
What the hell have they taken…??!!
A useful review of synthetic cannabinoids from the great minds of St. Emlyns. These present an increasing problem to the emergency physician and this simple review helps to revise the mechanisms and outline the key points in management.
Get the capnograph out…it’s not just for the anaesthetists!
An evaluation of capnography in the emergency department. The anaesthetists favourite is now becoming increasingly present in the emergency department, from procedural sedation and cardiac arrests to critical illness and trauma. This update from emDocs outlines in an accessible way the background and benefits of capnography in the ED.
Apneic Oxygenation…the ED angle!
This review from the guys at rebel em outlines the evidence behind the use apnoeic oxygenation in the emergency department. Its use seems to be proving a simple intervention which may reduce the incidence of hypoxia.
Sick kids!!! Aaaaargh…..or not actually!
Treating sick children is never a comfortable experience for an emergency physician. This entertaining video from Dr Rich Cantor goes through some interesting cases and highlights even the experienced sometimes forget the simple things. (Spoiler alert: DEFG)
Thats all for now.
DW
