This review article evaluated a key issue in treating patients with pulmonary embolisms without hospitalization. Overall, it was a good article as it analyzed a frequently encountered disposition for EM physicians. It concluded that patients with PE could possibly be treated without hospitalization in low-risk patients. Based on our discussion the observational setting is best for these patients. However, this article acknowledged the lack of data on outpatient management of PE patients and the studies selected for this were primarily observational studies.
Motov S. et al. Intravenous Sub-dissociative Ketamine vs. Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2015
This article evaluated the use of ketamine vs. morphine in the ED setting. This was an excellent article with a double blind RCT that concluded that ketamine (0.3mg/kg) can be used with similar efficacy to IV morphine for acute pain control. Based on our discussion the use of ketamine could be useful for chronic pain patients.
Weekes AJ, et. al. Central Venous Catheter Placement Evaluation Using Saline Flush and Bedside Echocardiography. Academic Emerg Med. 2013 21 ;65-72
This study evaluated the use of saline flush and bedside echocardiography to monitor CVC placement. It was a good article that illustrated a different technique to evaluate CVC placement than the traditional chest X-ray. It concluded that this technique using the Rapid Atrial Swirl Sign (RASS) on echocardiography could be used to evaluate the correct position of the CVC. This can be especially useful for a R IJ according to the article which indicated 100% sensitivity and specificity. Based on our discussion, this technique is beneficial due to the decreased time, cost, and radiation exposure versus a chest Xray. However, the article lacked more incorrect placements in their evaluation and this technique could not differentiate between arterial and venous placement. Thus, the discussion concluded that this technique could serve as an adjunct and the chest Xray remains as the standard of care.
Submitted by Dr. Ammar Ahmed, PGY-1