April 06, 2021

Droperidol for Agitation in the ED - No Danger to the Dangerous?

April 06, 2021/ Jeffery Hill, MD M.Ed

Droperidol is a versatile medication with a number of potential uses for patients in the Emergency Department. It is also a medication surrounded in some degree of mystique because of the decision by the FDA in 2001 to issue a black box warning for its use in response to reports of QT prolongation and torsades de pointes. Many at the time (and since) have argued that, despite these case reports, droperidol is a safe and effective medication that can be used for the treatment of agitation, nausea and vomiting, and migraine. We have previously covered much of this background in a previous blog post. In our most recent journal club, we discussed 3 articles that looked at the safety and efficacy of droperidol for treating acutely agitated patients. Take a read and listen below for an in depth look at each of these papers.

January 27, 2021

Old News and New News for Cardiac Arrest

January 27, 2021/ Jeffery Hill, MD M.Ed

Anyone who’s faced a patient with refractory V fib or V Tac, knows the certain pang of hopelessness that strikes when round and round of epi, CPR, and shocks fails to deliver a return to organized rhythm. ECMO is an option. Baring the availability of perhaps one of the most resource-intensive procedures in medicine, what option does one have? If nothing is working what do you change? Beta blockers? Change up the shocks? Is that bicarb you’re giving doing any good? This post and the affiliated podcast will cover 3 articles looking at the evidence for these new and old treatments for cardiac arrest.

October 25, 2020

Trio of Trauma - Journal Club Recap

October 25, 2020/ Jeffery Hill, MD M.Ed

The care of trauma patients is constantly evolving. From the time of injury to OR or ICU, there are dozens of management decisions that can improve the care and outcome for your patients. In our most recent journal club we took a look at 3 articles that looked at the management of trauma patients in the ED and ICU. Should we be adding vasopressin to our massive transfusion protocols? Is DL dead for trauma patients? Should we move to use IO’s early in traumatic arrests?

September 09, 2020

Ketamine Potpourri

September 09, 2020/ Jeffery Hill, MD M.Ed

In our most recent journal club, we took a look at 3 articles focused on the use of ketamine in the Emergency Department. When treating pain with ketamine, does a rapid administration of ketamine result in more dysphoria? When used for RSI, is ketamine more hemodynamically stable than etomidate? When using ketamine for procedural sedation in adult patients, does pre-treatment with versed or haldol decrease clinically significant emergence agitation?

April 07, 2020

Updates in Pediatric Cardiac Arrest

April 07, 2020/ Jeffery Hill, MD M.Ed

Pediatric cardiac arrests are, potentially, some of the most challenging patients for an emergency physician to care for. Cognitively, emotionally; these patients push us to our very limits. In this journal club recap, we cover 3 recently published articles looking at the care of these patients. Should survivors be cooled? Is Epi any good? Which is better amiodarone or lidocaine?

February 28, 2020

What to do about the Flu?

February 28, 2020/ Jeffery Hill, MD M.Ed

It’s the height of flu season and our most recent Journal. Club focused on a couple of papers digging into the treatment of influenza as well as the association of cardiovascular events with influenza infections. Take a read and a listen to hear about the utility (or potential lack thereof) of oseltamivir as well as the evidence behind a newer medication for treatment of influenza, baloxavir.

October 04, 2019

Sepsis Journal Club Roundup

October 04, 2019/ Jeffery Hill, MD M.Ed

The management of patients with sepsis can be exceptionally complex. As with many patient’s with complex critical illnesses, often times attention to seemingly minor aspects of the patient’s management can have significant impacts on the patient’s course of illness. In this recap of our most recent journal club, we review 3 such aspects of the care of patients with sepsis. Does the type of IV fluids really make a difference? Are steroids a friend or foe in the care of these patients? And can the simple bedside assessment of capillary refill replace serial measurements of lactate?

August 07, 2019

Controversies in Kidney Stones

August 07, 2019/ Jeffery Hill, MD M.Ed

Flank pain and pain due to ureterolithiasis are common ED presentations. There exist, however, a number of controversies when you dive into the literature addressing the diagnosis and treatment of nephrology/ureterolithiasis. Is IV lidocaine effective at treating pain in these patients? Is there a way to avoid CT scans? What about tamsulosin? Is it only good for big stones/small stones? Is there a benefit at all. For our most recent Journal Club, we tackled several of these controversies. Take a listen to the podcast below or over on iTunes.

June 30, 2019

Is the Cath Lab the Place to be after V fib VTac Cardiac Arrest?

June 30, 2019/ Jeffery Hill, MD M.Ed

Ventricular dysrhythmias are commonly caused by coronary ischemia which is most frequently caused by acute coronary artery occlusions in the setting of coronary artery disease. It would seem somewhat logical that patients who suffer a V fib or V Tach cardiac arrest would benefit from a trip to the cardiac catheterization lab to identify and treat these possible acute coronary artery occlusions. Patient’s with EKGs showing ST-elevations following ROSC already go to the Cath lab. Since the EKG is not terrifically sensitive for MI, should V fib V Tach cardiac arrest patients without ST-elevations make a trip to the Cath lab? In this breakdown of our most recent journal club we look at several papers covering this topic. In the podcast below we also talk with Justin Benoit, MD the site PI for the ongoing ACCESS trial which is also looking into this question.

March 27, 2019

Telling Tall Tales: Dogma in Emergency Medicine

March 27, 2019/ Jeffery Hill, MD M.Ed

In our training and education as Emergency Medicine providers, we often come to accept certain practice patterns as fact. When these established “facts” come along with fantastical clinical claims (don’t give your corneal abrasion patients tetracaine, it’ll melt their corneas; don’t use lido with epi for digital blocks, their finger will fall off; don’t use beta-blockers in patients on cocaine, their BP will skyrocket due to unopposed alpha-effects), we should probably look to question their supporting evidence.

March 01, 2019

Pneumonia Alphabet Soup

March 01, 2019/ Jeffery Hill, MD M.Ed

Pneumonia. It’s one of the first conditions we learn to diagnose as medical students. It was probably the cause of the first really sick, septic geriatric patient you saw in residency. Conversely you have also probably sent a fair share of patient’s home with an outpatient course of antibiotics and PCP follow-up. While determining the appropriate treatment and disposition for patients on the extreme ends of illness severity is quite straight forward; that pesky majority in the middle can be a conundrum at times. Who can go home? Who needs broad spectrum? Who needs step-down? Over the last two decades there has been a smorgasbord of pneumonia related acronyms used in clinical practice to predict severity, guide therapeutics and recommend disposition. During our most recent resident Journal Club, we took a look at a handful of the more familiar acronyms as well as some new ones coming down the pipeline.

October 03, 2018

A Weakness in the HEART?

October 03, 2018/ Jeffery Hill, MD M.Ed

In this month’s Journal Club Recap we take a look at some recently published literature about common heart related complaints in the ED. First, we look at the now nearly ubiquitously used HEART pathway. In a US population, do the benefits of decreased health care utilization sustain themselves to a year out of an index visit? Then we turn our attention to atrial fibrillation with RVR. Does the utility infielder of ED medications, Magnesium, actually help with more rapid rate control? And, should the results of a consensus panel sway us to treat A fib with RVR as an outpatient?

September 12, 2018

Bug Juice Potpourri

September 12, 2018/ Jeffery Hill, MD M.Ed

In this month's Journal Club, we covered several articles that looked at the use of antibiotics in the Emergency Department. Does adding Trimethoprim-Sulfamethoxazole to Cephalexin increase the rates of clinical cure in uncomplicated cellulitis? For patients receiving Vancomycin in the ED, how many are appropriately dosed and how many receive a sufficient number of doses to hopefully limit the emergence of resistant bacteria? Are patients receiving Vancomycin and Piperacillin-Tazobactam really at increased risk of acute kidney injury?

July 04, 2018

The Last Gasp

July 04, 2018/ Jeffery Hill, MD M.Ed

It is undoubted that effective airway management is a critical link in the care of patients with both in-hospital cardiac arrest and out-of-hospital cardiac arrest. But how exactly should one manage the airway? What results in the best outcomes for our patients? Should we be aiming to intubate every patient? Or, are extraglottic devices as effective (or more effective)? What about the good old bag-valve mask? In our most recent Journal Club we explored the evidence surrounding airway management in cardiac arrest, covering 3 high impact articles. We also touch on an abstract presented at the 2018 SAEM Academic Assembly which should add significantly to the body of literature when it is published in full. Take a listen to our recap podcast below and/or read on for the summaries and links to the articles.

May 30, 2018

Whole Blood - More than the Sum of Its Components?

May 30, 2018/ Jeffery Hill, MD M.Ed

Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?

A: If they've lost blood, give them blood.

It's never quite that simple though right? For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components. Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients. Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy. If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?

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SRU (pronounced "shrew") = Shock Resuscitation Unit

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