Pepper Spray Review

Pepper (oleoresin capsicum) spray is a commonly used riot-control and violence suppressive agent. It was first used by Federal Bureau of Investigation personnel in the US in 1973.  Commonly encountered effects include conjunctivitis, blepharospasm, and self induced corneal abrasions. Early decontamination minimizes the irritant effects.  Although the majority of the uses do not cause life threatening clinical effects many patients in custody or after exposure present to the Emergency Room. This wiki page will help you navigate the patient who just got Maced!Read more

Esophageal Foreign Bodies

Esophageal impaction can result in airway obstruction, stricture, or perforation. The perforation can be due to multiple mechanisms but is generally either mechanical (ingested bones) or via chemical corrosion (button battery). The most common sites of obstruction are the:

 

  • Cricopharyngeus (near C6) muscle is the most common (about 75%)
  • Aortic cross over the esophagus
  • Lower Esophageal Sphincter

Although uncomplicated food impactions (no bones, incomplete obstruction) can be managed expectantly, it should not be allowed to remain for  > 24hrs.  Endoscopy is the only difinitive method to ensure removal but carbonated beverages and glucagon can be considered. Only one RCT of glucagon with 24 patients compared glucagon to diazepam and found no difference in the need for endoscopy.Read more

Welcome Residency Directors

Welcome to WikEM!  The Emergency Medicine residency directory has received a lot of attention, and we encourage everyone affiliated with a residency to take a moment and edit their residency page.  These pages give access to important information for future and current EM residents.  The directory can be edited by any registered user so if your program or country is missing, please add it in.  Like all wiki pages, you will receive a notification by email any time anyone edits your residency page.

A few examples:

  • Residents can keep rotation scheduling up to date
  • Residency coordinators can ensure all contact information is accurate
  • Residency directors can highlight important facts for new applicants
  • Graduates can read about changes to their residency page and learn that the educational curriculum
Read more

Irrigation of cutaneous abscesses

The treatment of cutaneous abscesses classically involves the incision and drainage procedure. Historically, this procedure involves making a linear incision over the abscess cavity, followed by manual expression of cavity contents, blunt dissection to break up loculations, further irrigation with saline, and packing with gauze. However, a lack of data supports the routine use of irrigation to improve the success of the procedure and treatment of the abscess. In addition, while not typically considered, the routine use of irrigation does include some downsides: extra time and supplies, cost, and the possibility of microbiologic contamination of the patient care area and body fluid exposure to the practitioner.

The authors of this study randomized patients to I&D with or without… Read more

CHEST Recommendations Subsegmental PE

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The wiki has been updated with the recommendations for PE from a new CHEST guideline now that offers the option based on low quality (2C) evidence for clinical surveillance rather than anticoagulation for sub-segmental pulmonary embolism.  This excludes patients with proximal DVTs and those at risk for recurrent VTE (cancer patients, recent surgery, recurrent DVTs, decreased mobility, or hospitalization)

 

 … Read more