A Call for a Reconsideration of the Use of Fecal Occult Blood Testing in Emergency Medicine.

Background: Fecal occult blood testing (FOBT) was developed to detect microscopic bleeding caused by colorectal neoplasms. The role of FOBT in the emergency department (ED) is typically used for 5 different clinical workups: trauma, anemia, syncope, hypotension, and before the administration of systemic anticoagulants or thrombolytics.

Objective: We scrutinized the literature to assess the utility of FOBT for its 5 most common applications in the emergent setting.

Using pharmacists to optimize patient outcomes and costs in the ED.

Participation of hospital clinical pharmacists in the care of inpatients is widespread, often encouraged by the dicta promulgated by regulatory bodies. For years, clinical pharmacists have ventured out of the pharmacy to participate in rounds and, otherwise, in the care of patients on hospital floors and in intensive care units. In fact, it has been well documented in many research studies published in the last 20 years that having pharmacists prospectively involved with orders generates significant cost savings for the hospital and benefit to patients.

Procedural sedation and analgesia in the emergency department.

Purpose Of Review: Procedural sedation and analgesia is frequently administered outside of the operating room in emergency departments (EDs) and ICUs. Evidence was sought concerning patients' safety in the ED.

Recent Findings: Procedural sedation, when administered in the ED by trained personnel, is safe.

Point-of-care testing for coagulation studies in a stroke protocol: a time-saving innovation.

Study Objectives: Time counts in thrombolytic therapy for stroke. An international normalized ratio (INR) greater than 1.7 may preclude its use.

Lidocaine toxicity misinterpreted as a stroke.

For more than 50 years lidocaine has been used to treat ventricular arrhythmias. Neurologic dysfunction, manifested as a stroke, occurred acutely in an 87-year-old woman after she had been administered repeated doses of lidocaine, a lidocaine infusion, then an intravenous amiodarone infusion for ventricular tachycardia. This was ultimately diagnosed as lidocaine toxicity with a serum lidocaine level of 7.

Use of prehospital electrocardiograms for the treatment of patients with ST-segment elevation myocardial infarction.

Use of prehospital electrocardiograms (ECG) by emergency medical personnel may reduce door-to-balloon (DTB) time in patients with ST-segment elevation myocardial infarction (STEMI) referred for urgent percutaneous coronary intervention (PCI). A 79-year-old female awoke from sleep with severe substernal chest pain and called 911 for assistance. The patient was initially evaluated by advanced life support paramedics who performed a 12-lead ECG at the patient's home.

Trauma intubations: can a protocol-driven approach be successful?

Objective: To determine the success rate of a trauma airway protocol.

Methods: This was a prospective cohort study of trauma patients requiring intubation conducted for 24 months. The study facility is a Level I trauma center serving an urban population.

Sedation in the emergency department.

Purpose Of Review: The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic.

The esophageal-tracheal double-lumen airway: rescue for the difficult airway.

A rescue airway device is used when conventional methods of intubation fail to achieve control of the airway. Although the laryngeal mask airway is often used in the operating room should endotracheal intubation fail, the esophageal-tracheal double-lumen airway represents another alternative rescue airway device. Nurse anesthetists may encounter patients with an in situ esophageal-tracheal double-lumen airway placed in the field; in some locales, it is used as the primary approach to airway management by emergency services personnel.

Effects of a fast-track area on emergency department performance.

To determine if a fast-track area (FTA) would improve Emergency Department (ED) performance, a historical cohort study was performed in the ED of a tertiary care adult hospital in the United States. Two 1-year consecutive periods, pre fast track area (FTA) opening-from February 1, 2001 to January 31, 2002 and after FTA opening-from February 1, 2002 to January 31, 2003 were studied. Daily values of the following variables were obtained from the ED patient tracking system: 1) To assess ED effectiveness: waiting time to be seen (WT), length of stay (LOS); 2) To assess ED care quality: rate of patients left without being seen (LWBS), mortality, and revisits; 3) To assess determinants of patient homogeneity between periods: daily census, age, acuity index, admission rate and emergent patient rate.

Vocal cord dysfunction: an uncommon cause of stridor.

We present a case of vocal cord dysfunction syndrome (VCDS) presenting as acute angioedema of the upper airway. The presentation of this syndrome and its differentiation from other upper airway conditions that require far different and more urgent treatment is discussed.

A rare case of concomitant viral myocarditis and pericarditis in a 44-year-old patient.

Concomitant severe myocarditis and pericarditis are under-recognized or rare. We report a case of a 44-year-old woman who presented in shock after a week of a flu-like illness and several hours of severe back pain. Emergent echocardiography revealed cardiac tamponade for which pericardiocentesis achieved transient improvement.

Gastric rupture following bag-valve-mask ventilation.

Bag-valve-mask ventilation is a frequently used, generally safe and effective method of oxygenating and ventilating patients who are unable to do so themselves. The common complications of aspiration, inability to oxygenate, and gastric dilatation are recognized fairly quickly, although not always easily remedied. We report a case of a much rarer complication: gastric rupture with pneumoperitoneum.

Postpericardiotomy syndrome following minimally invasive coronary artery bypass.

A 62-year-old woman presented to the Emergency Department (ED) with chest pain, cough, subjective fever and chills. Symptoms had begun on the previous evening, three days after minimally invasive coronary artery bypass surgery (MICAB). A presumptive diagnosis of postpericardiotomy syndrome (postcardiac injury syndrome) was made and the patient admitted.