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Younger patients may perceive older anesthesiologists as more confident and intelligent. Female anesthesiologists may be perceived as more confident and more likely to be recommended to patients’ family members than males, but only in a subgroup of white patients.
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Postpartum hemorrhage is defined as ≥1000mL of blood loss irrespective of the delivery route, with associated shock. Remember the four “T’s”: tone (uterine atony), trauma (lacerations, uterine rupture), tissue (retained placenta, clots) and thrombin (coagulopathies). Manage the ABCs (especially two large bore IV’s for massive transfusion) and tailor treatment to the specific cause. Recommendations for balanced transfusion are derived from the trauma literature, but it is important to administer cryoprecipitate earlier to maintain a higher fibrinogen level (at term the normal level is >350mg/dL).
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In patients with suspected uncomplicated acute diverticulitis, consider ultrasound as a first approach.
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Emergency departments should reconsider using the HEART score and its variants due to significant concerns regarding the rule’s creation and performance.
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For ESBL, non-β-lactam antibiotics – like TMP/SMX or nitrofurantoin – usually work well for cystitis. For CRE or DTR-P. aeruginosa, look it up, call ID, and know this may mean alternative (and often expensive) antibiotics.
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Risk for post-LP headache can be lessened by using atraumatic non-cutting needles, which, contrary to popular belief, are not more difficult to use than traditional cutting needles. Utilizing the lateral decubitus position, a higher intervertebral space, and orienting the needle bevel parallel to the spinal axis may also decrease risk. Other common recommendations, including IV fluids, caffeine, and bed rest are unlikely to help.
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A standardized process for investigating patient-reported β-lactam allergies together with a side-chain cross-reactivity chart led to significantly increased use of structurally dissimilar β-lactams for surgical prophylaxis instead of alternate antibiotic classes.
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In-person ED scribes may improve financial productivity (RVUs) and clinical efficiency, though effects are probably small and good data are lacking. Insufficient data exist to determine impact on patient or clinician satisfaction, scribe documentation quality, or differences in scribe training.
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There was no statistical difference in endovascular therapy compared with usual medical therapy for patients with basilar artery occlusion.
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Clinician gestalt leaves much to be desired in determining which children with community acquired pneumonia will develop subsequent complications.
