Tuesday, September 20, 2022


SGEM#376 - September 17, 2022 - By admin
Reference: Gerlier C, et al. Differentiating central from peripheral causes of acute vertigo in an emergency setting with the HINTS, STANDING and ABCD2 tests: A diagnostic cohort study. AEM 2021
The paper we will discuss compares the HINTS exam to the STANDING protocol. STANDING is an algorithm by Dr. Vanni et al. published in Frontiers in Neurology 2017.


High-Risk Syncope Mnemonic

emDOCs - September 19, 2022 - By Matthew Christensen and Kristy Schwartz
Reviewed by: Jamie Santistevan; Manpreet Singh and Brit Long
Syncope is a relatively common chief complaint in the emergency department, with a broad differential that ranges from reassuringly benign to acutely life-threatening. While there is no substitute for a thorough history and physical exam, obtaining an electrocardiogram (ECG) is a key aspect of nearly every syncope workup. Prompt recognition of high-risk ECG patterns is a critical skill for emergency medicine attendings, residents, and medical students alike. Here we introduce the mnemonic “ABCDE Left Right”, a memory aid to help EM providers quickly recall seven ECG patterns of high-risk syncope: AV block, Brugada pattern, QTc prolongation, delta waves (Wolff-Parkinson-White), epsilon waves (arrhythmogenic right ventricular cardiomyopathy), left ventricular hypertrophy, and right ventricular strain.
For a refresher on the broader approach to syncope in the emergency department and take a closer look at non-cardiac causes of syncope, see the emDocs article Syncope and Syncope Mimics.

Saturday, September 17, 2022

Diltiazem O Metoprololo

empills - 14 September 2022 By Federica Liegi
Lo studio
Conclusioni degli autori dello studio:
Il Diltiazem è più efficace del Metoprololo nell’ottenere il rate-control nei pazienti che accedono in Pronto Soccorso con diagnosi di Fibrillazione atriale ad elevata risposta ventricolare nei primi 30 minuti – e ad ogni misurazione della FC (5’-10’-15’-20’-25’-30’) – dalla somministrazione del farmaco, in assenza di un significativo aumento dell’incidenza di eventi avversi, come bradicardia o ipotensione.

Optic Neuritis

emDOCs - September 12, 2022 - By Tallib Karaze and Matt Baluzy
Reviewed by: Courtney Cassella; Alex Koyfman; Brit Long
Take Home Points
  • Optic neuritis is a clinical diagnosis and presents with acute vision change, pain with eye movements, changes in color vision, and an RAPD on exam. Additional studies such as MRI, POCUS, serum, and CSF studies can aid in the diagnosis.
  • Neurology, ophthalmology, or a neuro-ophthalmologist should be consulted to help guide management decisions.
  • Treatment options for typical optic neuritis include three days of either IV methylprednisolone or high dose oral prednisone, followed by low-dose oral prednisone and a steroid taper if needed.

Acetazolamide in ADHF

REBEL CRIT, REBEL EM - September 15, 2022 - By Salim Rezaie
Paper: Mullens W et al. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload. NEJM 2022. PMID: 36027559 [Access on Read By QxMD
Clinical Question: Does the addition of acetazolamide to loop diuretics lead to more and faster decongestion in patients with acute decompensated heart failure with volume overload?
Author Conclusion: “The addition of acetazolamide to loop diuretic therapy in patients with acute decompensated heart failure resulted in a greater incidence of successful decongestion.”
Clinical Take Home Point: In patients with acute decompensated heart failure, and clinical signs of volume overload (i.e. edema, pleural effusion, or ascites) the addition of 500mg of IV acetazolamide to standard loop diuretic therapy resulted in more diuresis, more natriuresis, shorter hospital stay, and an increased likelihood of being discharged without residual signs of volume overload.

Friday, September 9, 2022

HFNC vs NC for RSI

REBEL Cast Ep112 - By Salim Rezaie - September 08, 2022

Paper: Chua MT et al. Pre- and Apnoeic High-Flow Oxygenation for Rapid Sequence Intubation in the Emergency Department (the Pre-AeRATE Trial): A Multicentre Randomised Controlled Trial. Ann Acad Med Singap 2022. PMID: 35373238 [Access on Read by QxMD]
Clinical Question: Does HFNC oxygenation for preoxygenation and apnoeic oxygenation maintain a higher oxygen saturation (SpO2) during RSI in ED patients compared to usual care (Nasal Cannula)?
Author Conclusion: “Use of HFNC for preoxygenation and apnoeic oxygenation when compared to usual care, did not improve lowest SpO2 during the first intubation attempt but may prolong safe apnoea time.”
Clinical Take Home Point: I am not surprised by these results. In a population of predominantly neurologic emergencies, HFNC used for preoxygenation and apneic oxygenation did not show improvement in median lowest SpO2 achieved during the 1st intubation attempt. However, HFNC did seem to prolong safe apnea (≈3min) and decrease the risk of SpO2 falling below 90% compared to NRB + NC. HFNC could be considered as an intermediary step for patients in cardiopulmonary extremis or with perceived difficult airways when not tolerating NIV.

Tuesday, September 6, 2022

New in OCHA

MEDEST - By Mario Rugna - September 06, 2022
Chest compressions alternate to abdominal compression–decompression technique
For prehospital use of combined chest compression and abdominal compression–decompression cardiopulmonary resuscitation we have first of all to account the need of an additional rescuer to perform abdominal compression-decompression. By the way the alternate chest/abdominal compression-decompression method is promising even if we need larger multicenter randomised trial for a more consistent evaluation of its efficacy.
Head and thorax elevation during cardiopulmonary resuscitation
There are still insufficient historical data to understand the benefit of automated controlled elevation (ACE) CPR and this study doesn’t clear any doubt about it’s efficacies on clinical oriented outcomes.
Aortic occlusion during cardiac arrest. Mechanical adrenaline?
REBOA in Cardiac Arrest is potentially useful to increase CPP and less dangerous than epinephrine administration. 
It’s feasibility in emergency (in-hospital and out of hospital) settings in a timely manner and with a small number of medical personnel needs to be demonstrated.

BP & O2 Target with ROSC

REBEL Crit - By Salim Rezaie - September 05, 2022
Clinical Take Home Point: 
In comatose adult patients, with presumed cardiac etiology of their cardiac arrest, with ROSC…
  • There appears to be no difference between a restrictive vs liberal oxygenation target regarding the incidence of death or severe disability or coma at 90 days.
    • will continue to titrate FiO2 to maintain a PaO2 range of 68 to 105mmHg (based on this trial) or an SpO2 of 90 to 95% (my bedside practice) in the post arrest setting.
  • There appears to be no difference between targeting a lower mean arterial pressure (63mmHg) vs a higher mean arterial pressure (77mmHg) regarding the incidence of death or severe disability or coma at 90 days.
    • I will continue to target a mean arterial pressure of ≥65mmHg in the post arrest setting.

Complications of Stroke Therapy

EM Ottawa - By Emma Ferguson & Lucy Karp - September 01, 2022
Acute stroke care is integrated into emergency medicine in many emergency departments across Canada. Whether you are involved in acute stroke care through consultation with neurology or through tele-stroke, understanding the complications of acute stroke therapy and evidence around treatment options is essential. Specifically, in this blog post we will focus on the following:
  • Orolingual angioedema post thrombolysis for acute ischemic stroke
  • Approach to post-thrombolysis intra-cranial hemorrhage (ICH)
  • Approach to seizure in the stroke patient

Thursday, August 25, 2022


canadi EM - August 25, 2022 - By Braedon Paul
…Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
Traditionally, resuscitative thoracotomy (RT) with aortic cross-clamping has been the intervention of choice for achieving control of non-compressible torso hemorrhage (NCTH) for patients in extremis (i.e., severe hemodynamic compromise). This is, of course, a temporizing measure until definitive surgical management can be obtained.​ Despite what the writers of Grey’s Anatomy or ER want us to think, survival rates following ED thoracotomy for penetrating abdominal trauma are somewhat disheartening (around 9% based on 25 years of data from 2000).​
In more recent literature, resuscitative endovascular balloon occlusion of the aorta (REBOA – not to be confused with country music sensation, Reba) has been suggested as an alternative to RT for achieving NCTH control for life-threatening bleeds.​ As the name suggests, REBOA involves deploying an occluding balloon in the distal thoracic or distal abdominal aorta (depending on the site of injury), typically via the femoral artery, to gain hemorrhage control and thus improve proximal perfusion to the brain and coronaries.​..

A video demonstrating this technique with the ER-REBOA catheter system can be viewed here: ER-REBOA™ Procedure – YouTube

Wednesday, August 24, 2022

Mesenteric Ischemia

emDOCs - August 23, 2022 - By Alex Koyfman
Reviewed by: Brit Long and Manpreet Singh
Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.
  • What are the four types of mesenteric ischemia?
  • What are the major risk factors for mesenteric ischemia?
  • How can this disease present, and how does it relate to the pathophysiology of each type?
  • What are pitfalls with laboratory evaluation?
  • What imaging is recommended, and what are pitfalls?
  • What is the ED management?
  • What specialists should be consulted?

Tuesday, August 23, 2022

Ocular PoCUS

EM Ottawa - August 18, 2022 - By Joyes Botros, Wilson Lam, Rajiv Thavanathan
POCUS can be a useful adjunct to the eye exam when seeing a patient with visual disturbances in the emergency department. It can be useful in detecting increased optic nerve sheath diameter and optic disc elevation suggestive of increased intracranial pressure. It may also be useful in seeing a thick or thin hyperechoic membrane which may suggest retinal detachment or vitreous detachment, respectively. In patients with vitreous hemorrhage, you may see a washing machine sign. Finally, look out for the retrobulbar spot sign indicative of central retinal artery occlusion. On your next shift, try using POCUS to help you gain more information to integrate into your clinical case and help you diagnose your ocular emergencies.

Non-Sterile Gloves for Suturing

REBEL EM - August 22, 2022 - By Salim Rezaie
Paper: Zwaans JJM et al. Non-Sterile Gloves and Dressing Versus Sterile Gloves, Dressings and Drapes for Suturing Traumatic Wounds in the Emergency Department: A Non-Inferiority Multicentre Randomised Controlled Trial. Emerg Med J 2022. PMID: 35882525 [Access on Read by QxMD]
Clinical Question: Is the use of non-sterile materials (gloves, dressings, and drapes) non-inferior to sterile materials in the rate of wound infection after suturing traumatic lacerations?
Author Conclusion: “Although recruitment ceased prior to reaching our planned sample size, the findings suggest that there is unlikely to be a large difference between the non-sterile gloves and dressings for suturing of traumatic wounds and sterile gloves, dressings and drapes for suturing traumatic wounds in the ED.”
Clinical Take Home Point: Although underpowered, this trial suggests that there is no significant difference between non-sterile gloves/dressings compared to sterile gloves/dressings/drapes in the suturing of traumatic wounds and the risk of infection. Due to the small numbers of patients with diabetes mellitus, immunosuppressed and on corticosteroids, caution should be applied to extrapolating these results in those populations.

CCB Intoxication

empills - 22 Agosto 2022 - di Isabelle Piazza
L’intossicazione da CCB causa quindi problematiche con due modalità:
  1. Blocca i canali del Ca nelle cellule miocardiche e muscolari lisce dei vasi
  2. Causa ipoinsulinemia che a sua volta contribuisce alla tossicità diminuendo la quantità di glucosio intracellulare per i cardiomiociti provocando un viraggio del metabolismo verso un maggiore utilizzo di acidi grassi, meno efficienti dal punto di vista energetico
HIET – Hyperinsulinemia Euglycemia Therapy

Monday, August 22, 2022

Nausea and Vomiting

emDOCs - August 22, 2022 - By Marie J. Murphy and Ian S. deSouza
Reviewed by: Marina Boushra; Alex Koyfman
Take Home Points
An accurate history of present illness, a thorough review of systems, and a broad differential diagnosis will help identify the underlying cause of nausea/vomiting

Saturday, August 20, 2022

Agitation in the ED

Canadi EM - By Edward Feng - August 11, 2022
Canadi EM - By Edward Feng - August 18, 2022

…We hope to leave readers more comfortable dealing with these common yet extremely important situations in the ED, all while keeping the 4 objectives of the American Association of Emergency Psychiatry (AAEP) at the forefront​: 
  1. Ensure the safety of the patient, staff, and others in the area.
  2. Help the patient manage their emotions and distress and maintain or regain control of their behaviour. 
  3. Avoid the use of restraints when at all possible. 
  4. Avoid coercive interventions that escalate agitation.

N-ATBs in Mild Acute Diverticulitis

REBEL EM - By James C. Fletcher - August 18, 2022
The Paper: Mora-López, L. et al. Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO Study). Annals of Surgery, 2021. PMID: 34183510 [Access on Read by QxMD]
Clinical Question: Is it necessary to prescribe antibiotics to all patients undergoing outpatient management for mild diverticulitis as identified on CT scan?
Author Conclusion:Nonantibiotic outpatient treatment of mild AD is safe and effective and is not inferior to current standard treatment.”
Clinical Bottom Line: Otherwise healthy patients presenting to the Emergency Department with mild acute diverticulitis, no signs of severe infection/sepsis, and who achieve good symptom control in the ED may be discharged home with symptomatic management and close follow-up only, and may not require antibiotic therapy.

Tuesday, August 16, 2022


emDOCs Podcast Episode 60 - By Brit Long - August 16, 2022
Key Points:
  • S. aureus is the most common cause of abscess.
  • Abscess, like cellulitis, is a clinical diagnosis. Labs and imaging are not usually needed in evaluating or managing an abscess.
  • POCUS can assist with abscess identification and drainage.
  • Incision and drainage is the treatment of choice. Some patients should be treated with antibiotics.
  • Admit the patient for parenteral therapy when not tolerating PO antibiotics, rapid progression of erythema, severe infection, and/or proximity of the lesion to an indwelling medical device.

ECG in Aortic Dissection

Emergency Medicine Cases - ECG  Cases 34 - By Jesse McLaren
Peer Reviewed and edited by Anton Helman - August 2022
Take home points for ECG in aortic dissection
  • The ECG in aortic dissection can range from normal, to chronic LVH, to acute ST/T changes
  • ECGs diagnostic of acute coronary occlusion are unlikely to be secondary to aortic dissection, and CT scans to rule out aortic dissection lead to reperfusion delays
  • Non-diagnostic ECGs require other tests (including POCUS) guided by pre-test probability

Monday, August 15, 2022

Basic EM

REBEL EM - June 01, 2022 - By Ellsworth Wright
Take Home Points
  • Emergency medicine revolves around the differential diagnosis
  • History and physical exam should significantly narrow your differential diagnosis
  • Have an idea of what specific diagnoses are being ruled out when ordering diagnostic tests
  • Always consider the most life-threatening and most common disease processes first – we are a rule out specialty
  • “Red flags” are key historical or physical exam findings that put one at a higher risk for certain conditions
  • You have a finite number of shifts as a learner. Challenge yourself to learn something new every day!

Saturday, August 13, 2022

Viruela del mono

El Ministerio de Sanidad ha publicado las nuevas Guías de Manejo de casos de Viruela del Mono, en las cuales ha participado la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). El objetivo de dichos documentos es para mejorar el diagnóstico, tratamiento y prevención entre los diferentes grupos de enfermos: ambulatorios, hospitalarios y pediátricos.
Desde SEMES, compartimos con nuestros socios las diferentes guías:
Acceda a la web del Ministerio de Sanidad

Tuesday, August 9, 2022

Calcium and blood products in trauma

St Emlyn’s - By Simon Carley - August 09, 2022
This week we have a nice paper that highlights some of the ongoing thoughts and controversies about the use of calcium in major haemorrhage protocols. Hopefully you’ve already read Iain’s excellent review of the matter here which is well worth a read together with the links at the end of this article. You should probably also read up on the RePHILL trial of blood in major trauma patients which has it’s own controversies and nuances that are asking questions of those organisations using prehospital blood products…”

Video Laryngoscopy

EemDOCs - August 08, 2022 - By Cameron Jones
Reviewed by: Bryant Allen; Alex Koyfman; Marina Boushra; Brit Long
Take-Home Points
  • Video laryngoscopes include standard-geometry blades (SGVL), hyper-angulated blades (HAVL), and hyper-angulated blades with an ET tube channel.
  • While SGVL involves similar technique to classic DL blades, HAVL requires a specific skill set, particularly when it comes to tube insertion.
  • There is some evidence that VL may increase first-pass and overall intubation-success rate, but the data in ED-based studies is still mixed.
  • The availability of SGVL also makes the “VL vs DL” debate obsolete, and EPs should instead focus on building both HAVL and SGVL into their airway algorithms.
  • There is limited evidence comparing HAVL and SGVL, and future prospective trials may inform selection of specific devices for certain clinical scenarios.

Saturday, August 6, 2022

HIV in the ED

EMOttawa - By Alex Viau, Josee Malette, Alex Coutin - July 28, 2022
EMOttawa - By Alex Viau, Josee Malette, Alex Coutin - August 04, 2022

In this two-part blog series, we hope to outline the following:
  • Part 1: 
    • The UNAIDS 90-90-90 guidelines and the importance of early recognition in order to engage patients with early ART;
    • The 3 phases of HIV infection and the Acute Retroviral Syndrome (ARS);
    • PublicHealth Agency of Canada (PHAC) and Center for Disease Control (CDC) recommendations for testing and how it works at The Ottawa Hospital.
  • Part 2: 
    • Indications for occupational and non-occupational post-exposure prophylaxis (PEP);
    • Indications and resources for pre-exposure prophylaxis (PrEP);
    • Barriers to patient engagement and ways we can overcome them.

Decompression Syndrome

Empills - By Davide Tizzani - 05 Agosto 2022
La malattia da decompressione (DCS) si verifica durante la depressurizzazione quando i gas disciolti durante la discesa (solitamente azoto o elio, utilizzati nelle immersioni) formano bubbles (bolle) a rischio di “intrappolamento” all’interno del singoli tessuti. La DCS si verifica durante la salita nella decompressione subacquea, nel lavoro nei cassoni, in volo in un aereo non pressurizzato, in attività extraveicolare da veicoli spaziali. Una appropriata procedura di decompressione può ridurre l’incidenza di DCS. 
Gli esperti hanno classificato due tipologie di malattia: la tipo 1 con sintomi solamente muscoloscheletrici o cutanei, solitamente di lieve entità; il tipo 2 con sintomi a carico del SNC e manifestazioni cardiopolmonari.

EM Rash

REBEL Core Cast - June 01, 2022 - By Ellsworth Wright
Take Home Points
  • Examine all parts of the body, even inside the mouth – this can be the difference between benign and life threatening rashes
  • Truly emergent causes: meningococcemia, TTP, DIC, TSS, SJS, TEN, and necrotizing fasciitis
  • Toxic appearing patients with petechia/purpura = sepsis until proven otherwise
  • Look for medication reactions: Sulfa, Penicillins, NSAID’s, ABX, Chemo, Anti-epileptic agents
  • It’s ok not to know the cause – know the life threatening rashes and rule them out – refer to dermatology out patient
  • TTP – get smear, heme/onc consult, plasmapheresis, and AVOID giving platelets – they will just get chewed up – fix the underlying issue

Tuesday, August 2, 2022


Emergency Medicine Cases (Ep172) - By Helman, A. Carr - August 2022 
In this main episode podcast, Dr. David Carr joins Anton to give us his simplified approach to syncope based solely on history, physical and ECG to help guide disposition decisions. We answer questions such as: What features have the best likelihood ratios to help distinguish syncope from seizure? What key clinical features on history and physical exam can help us distinguish orthostatic and reflex syncope from the more sinister cardiac syncope? What is the best approach to ECG interpretation for the patient who has presents with syncope? Are syncope clinical decision tools any better than physician gestalt? and many more….The ED approach to syncope is almost entirely based on a focused but thorough history, cardiac physical exam and ECG rather than laboratory tests and imaging. The first step is distinguishing syncope from seizure. The next step is distinguishing cardiac from non-cardiac syncope. Our ultimate aim is to make safe disposition decisions based on this approach.

Monday, August 1, 2022

Sciatica Mimics

emDOCs - August 01, 2022 - Authors: Mitchell Blenden and Kelly Williamson
Reviewed by: Alexander Y. Sheng; Alex Koyfman; Brit Long
Key Points
  • Sciatica is a diagnosis of exclusion in the emergency department. It is important to assess for red flag symptoms that should prompt further evaluation.
  • Important diagnoses to consider that may mimic sciatica include spinal cord compression, infectious processes, malignancy, and acute limb ischemia.
  • There is no perfect test for sciatica. History and physical exam should be used together to make this diagnosis.
  • The treatment of sciatica is pain control with NSAIDs. The utility of corticosteroids is controversial. Opioids and benzodiazepines have no proven benefit.

ICH Score

NeuroEMCrit - August 1, 2022 - By NeuroEMCrit Team (Casey & Neha)
In summary: 
  • The ICH score is a number that is helpful in conveying disease severity
  • Limitations include that it was determined from a cohort in which early withdrawal of care was allowed which biases towards the self-fufiling prophecy
  • Like many scores, it captures neither the context of injury nor patient specific factors such as frailty and reserve. 
  • Use it as part of the diagnostic evaluation, but not as a determination of who gets maximally aggressive care and who doesn’t!

Sunday, July 31, 2022

US for SBO

SGEM#373 - By admin - July 30, 2022
Reference: Brower et al. Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure. AEM July 2022


Saturday, July 30, 2022

Impaled Objects

emDOCs / EM@3AM - July 30, 2022 - By Sarah Shaver, Tony Mathew and Dylan Beam
Reviewed by: Alex Koyfman and Brit Long
  • Impaled objects resulting in penetrating injuries can be potentially life or limb threatening depending on the location, depth, and involved neurovascular structures.
  • EMS should leave the impaled object in place while in the field and during transport to the ED.
  • These patients should be treated as trauma patients, and emergency clinicians must perform a thorough primary and secondary survey to ensure all wounds and injuries are identified.
  • The majority of impaled objects will require removal in the OR, and all unstable patients due to impaled objects should be expeditiously taken to the OR. Stable patients can first undergo further imaging and evaluation to identify the extent of injury.

Wednesday, July 27, 2022

Patient Safety

EM Ottawa - By Evelyn Tran & Lucy Karp - July 21, 2022 
What is patient safety?
  • Patient safety is a discipline developed in response to the rise in hospital adverse events over the years.
  • Aims to take lessons learned from prior unfavourable outcomes and make improvements that mitigate risks, prevent errors, and reduce harm.
  • The World Health Organization (WHO) recognizes patient safety as a global health priority
  • Patient Safety allows us to evolve alongside our increasingly complex health care system.

Sudden hearing loss

First10 EM - By Justin Morgenstern - July 25, 2022
The Paper: Chandrasekhar SS, Tsai Do BS, Schwartz SR,et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019 Aug;161(1_suppl):S1-S45. doi: 10.1177/0194599819859885. PMID: 31369359.
Emergency Medicine translation
In a patient with sudden hearing loss, your job is to distinguish between conductive and sensorineural hearing loss. For sensorineural hearing loss, conduct a thorough history and physical, but barring abnormalities, you should not order lab testing or imaging. Our primary job is to counsel patients, with the understanding that almost all cases are idiopathic, and that about half resolve on their own, but that there is a risk of permanent hearing loss and tinnitus. The evidence for treatment is mixed and inconclusive. Steroids might be used, and in certain centers hyperbaric oxygen is considered. Talk with your local ENT group to determine their preference, but based on the low quality evidence discussed, I doubt that either helps.. Urgent follow-up is key, as these patients need urgent audiometry, but also may benefit from procedures such as intratympanic steroids.

Tuesday, July 19, 2022

Blood glucose rise with DW50

EM Pharm Pearls - July 18, 2022 - By: Bryan D. Haye
A common question is how much should we expect the blood glucose concentration to increase after dextrose 50% (D50) administration. Fortunately, there is an answer from 3 studies.
Take Home Points
  • Glucose concentrations increase 4-6 mg/dL per gm of dextrose administered50 mL of D50 = 25 gm = expected 100-150 mg/dL glucose rise
  • D50 rescue glucose is short-lived (30 minutes)
  • If the blood glucose does not respond as anticipated, investigate further (e.g., IV decannulation)

Monday, July 11, 2022

Suicidal Patient

emDOCs - July 11, 2022 - By Noah Rohrer and Maxine Dudek
Reviewed by: Courtney Cassella; Alex Koyfman; Brit Long

Take-home Points
  • Suicidal ideation is common, dangerous, and requires appropriate clinical assessment.
  • Presence of suicidal thinking with any high-risk factor including a history of prior suicide attempt, recent psychosocial stressor, older age, Caucasian race, psychiatric illness, or substance abuse likely qualifies an individual as at least moderate risk and should prompt consideration of involuntary hold and psychiatry consultation.
  • For a structured and comprehensive approach toward suicide risk assessment, we recommend using the Columbia Suicide Severity Rating Scale.
  • Document in your note the protective factors and risk factors that justify your determination of risk and decision to either involuntarily hold for psychiatric consultation or discharge home.