A 6 year study on the usage of WikEM by emergency medicine graduates and current residents has been published in JAMIA.… Read more

A quick pearl on the INR stratified guidelines for warfarin reversal.… Read more

For April and May, editors will be completing the Bactrim for Abscess and the ALPS Trial journal club summaries. All contributions are welcome.… Read more

As an experiment, WikEM has a forum for all practitioners to join in discussion… Read more

EmCare® is seeking emergency medicine physicians for several sites in and around Houston. Come join the country’s most experienced, physician-led practice management company.

• Clear Lake Regional Medical Center (Webster, TX)
• Bayshore Medical Center (Pasadena, TX)
• East Houston Medical Center (Houston, TX)
• Pearland Medical Center (Pearland, TX)

Known for its unique structure, EmCare® develops local practices, supports them with regionally-located clinical leadership and operational personnel, while providing them access to unprecedented national resources.

Contact Stacey Harris, EmCare® physician recruiter, at (214) 712-2477 or Stacey.harris@emcare.com

Support open medicine and become a WikEM Sponsor! … Read more

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

For diagnosing “Temporal Arteritis”, the American College of Rheumatology recommends meeting 3 of their 5 criteria.

• Age ≥ 50 years old
• New onset of headache
• Temporal artery tenderness or DECREASED temporal pulse (not related to carotid disease)
• ESR ≥ 50 mm/hr
• Artery biopsy with necrotizing arteritis or a granulomatous process with multinucleated giant cells

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

The new Sepsis and Septic Shock definitions were presented at the Society of Critical Care Medicine’s Critical Care Congress and were published online in JAMA. 

New Sepsis Definition:

• Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection

Septic Shock is sepsis and any of the following:

• Vasopressor requirement to maintain a mean arterial pressure > 65 mm Hg
• Serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia.

At the core of altitude medicine, is an understanding of acclimatization. The earliest sign of acute mountain sickness is a headache, while the formal diagnosis of Acute Mountain Sickness requires a headache + 1 or more of the following:

Nausea, vomiting, anorexia
Fatigue or weakness
Dizzy or lightheadedness
Difficulty sleeping

More serious complications include HAPE, HACE, pharyngitis, UV keratitis, and peripheral edema.

When symptoms progress to ataxia or confusion, be very worried about HACS.   Although the initial treatment is always descend until symptoms begin to resolve, administration of oxygen and acetazolamide along with dexamethasone 8mg initially followed by 4mg q6hrs  may aid in early recovery.… Read more