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Push-Dose Pressors in the Emergency Department

ACEP Now

My goal in this column is to share tips, tricks, and emerging concepts from the intensive care unit (ICU) that you can use on your next shift in the emergency department (ED). 1 Push-dose pressors can come in handy in three situations: Anticipated transient hypotension. What is a Push-Dose Pressor? Epinephrine (“epi”).

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The Evidence for Empathy in the Emergency Department

ACEP Now

The emergency department (ED) is full with boarding and critical patients, and 25 patients are in the waiting room. What is the emergency physician’s role? 1 According to the ACEP Code of Ethics: The physician-patient relationship is the moral center of medicine and the defining element in clinical ethics. 2017;17(1):136.

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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. Xylazine withdrawal is controversial.

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US Probe: Assessing Venous Congestion – The VExUS Approach

EMDocs

1 Even beyond the assessment of volume tolerance, there is suggestion that the VEXUS scan can be used to guide decongestion from heart failure, 2 guide the decision for dialysis 3 , and identify different venous congestion as it mimics different pathologic states such as cardiogenic shock or cholecystitis. 2020;12(1):16.

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Elbow Dislocations

REBEL EM

1998 Jan-Feb;6(1):15-23. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9. 2022 Aug 2.

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EM@3AM: Stercoral Colitis

EMDocs

3, 9, 11, 12 The average age tends to be greater than 60 years old. Up to 1/3 of adults over 60 suffer from chronic constipation. Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis.

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Ultrasound Diagnosis of Necrotizing Soft Tissue Infections

Core EM

SUMMARY: Upon initial evaluation of patients in the emergency department with clinical signs of soft tissue infections, consider using POCUS as a valuable tool to gather more information in patients with a high suspicion for the diagnosis and/or are too unstable to undergo CT imaging. REFERENCES: Castleberg E, Jenson N, Dinh VA.

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