Contributor: Aaron Lessen, MD Educational Pearls: Prior, smaller studies showed intravenous Vitamin C given to patients with sepsis significantly improved patient mortality and additional outcomes. A recently published, randomized control trial with >800 ICU patients who received up to 4 days of IV Vit C or placebo concluded that the end points of death or…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Septic shock management has traditionally endorsed rapid fluid resuscitation and the administration of vasopressors Current guidelines are for patients to initially receive a 30 ml/kg fluid bolus then additional fluid as needed for continued hypotension The ideal volume of fluid needed to maximize patient outcomes has been debated A…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Lithium remains a commonly used medication for treating bipolar disorder Lithium toxicity can be acute, acute-on-chronic, or chronic Measuring blood lithium level Therapeutic range of lithium is around 1.6-1.8 mEq/L >2 mEq/L is likely to cause significant toxicity >4 mEq/L necessitates lifesaving treatment The lethal dose of lithium is…
Read MoreContributor: Don Stader, MD Educational Pearls: Pain sensation is generated and modified by the brain Multiple case reports provide evidence that the degree of pain a patient experiences correlates with how severe they perceive their injury/illness to be Patients who feel safe and reassured about the care they are receiving have less pain The patient’s…
Read MoreContributor: Peter Bakes, MD Educational Pearls: When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: There are several online products that have been marketed towards individuals with SI Sodium nitrite Food preservative that can cause methemoglobinemia when ingested in large amounts Patients present with blue skin discoloration and severe respiratory distress Treat with methylene blue to reduce methemoglobin back to hemoglobin Formic acid and…
Read MoreContributor: Jarod Scott, MD Educational Pearls: Rectal prolapse is an evagination of the rectal tissue through the anal opening Factors that weaken the pelvic floor muscles increase the risk of rectal prolapse These include age > 40, female, multiple pregnancies, constipation, diarrhea, cystic fibrosis, prior pelvic floor surgeries, or other pelvic floor abnormalities Noninvasive treatment…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: NSAIDs are a potential alternative to opioids for pain management and are associated with decreased rates of adverse effects A recent study evaluated the effectiveness of ibuprofen and oxycodone for pain management in pediatric patients with isolated, acute-limb fractures Participants were discharged home with either ibuprofen or oxycodone and…
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