Thursday, August 22, 2019

Does Albumin as Resuscitative Fluid in Sepsis Improve Mortality When Compared to Crystalloid?

Image Credit: Wikimedia
This post was peer reviewed.
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Authors: Laurie Bezjian Wallace, DO
Mike O’Callaghan Military Medical Center

Bottom Line Up Front
Utilizing albumin as resuscitative fluid in patients with sepsis demonstrated no difference in all-cause mortality when compared to crystalloid (System of Record ((SOR)) A: meta-analysis of randomized controlled trials [RCTs]). Administration of 300mL of 20% albumin did not significantly lower mortality rates at 28 days or 90 days post-administration (SOR B: single unblinded RCT).

Introduction
Crystalloid versus colloid fluid resuscitation in septic patients remains a topic of discussion within the critical care community. This article details a meta-analysis and RCT which address the outcomes of utilizing albumin as a resuscitative fluid in patients with sepsis.

Friday, August 16, 2019

Resident Journal Review: Update on Attitudes Towards Patients with Sickle Cell Disease and Effects on the Provision of High-Quality Care in the Emergency Department

Authors: Hannah Goldberg, MD; Sharleen Yuan, MD PhD; Samantha Yarmis, MD
Editors: Kami M. Hu, MD FAAEM and Kelly Maurelus, MD FAAEM
Originally published: Common Sense January/February 2019

Question
Do emergency physicians have biases towards patients with sickle cell
disease and do biases affect the delivery of appropriate care?

Introduction
Many patients with sickle cell disease (SCD) have disease that is well managed in the outpatient setting. However, among patients with severe symptoms of SCD, there is a high recidivism rate in the emergency department (ED).[1] Care of patients with sickle cell disease with vasoocclusive crises (VOC) can often elicit frustration on the part of both the patient and the emergency physician due to many factors. These patients tend to have pain that is difficult to assess, as well as a high opiate tolerance requiring large doses to control pain. Additionally, physicians can have negative feelings about patients with sickle cell disease, with hesitancy regarding redosing of parental opioids due to concerns about opiate addiction and drug-seeking behavior.[2] These exist despite evidence that patients with sickle cell generally present with less outward distress or vital sign abnormality despite sincere pain and that lab-work does not correlate to presence of VOC or severity of associated discomfort.[3] We attempt to discern how pervasive these negative biases may be and whether or not they affect patient care.

Friday, August 9, 2019

Be Alert to Potential Loperamide Abuse and Resulting Cardiotoxicity

Originally published: Common Sense November/December 2018

This article was contributed by LoperamideSafety.org which is maintained by Consumer Healthcare Products Association (CHPA). They are an advocacy group for the consumer healthcare products industry (https://www.chpa.org/About.aspx).
 

A small, but growing, number of people are intentionally misusing loperamide (also sold
under the brand name Imodium®). Approved by the U.S. Food and Drug Administration (FDA) to relieve the symptoms of diarrhea. This overthe- counter (OTC) and
prescription medication is safe and effective when used as directed. Some individuals are consuming very high doses of loperamide to self-manage their opioid withdrawal or to achieve a euphoric high, putting them at risk for cardiotoxicity.

It is important to recognize the signs and symptoms associated with loperamide abuse and address them appropriately with patients who may be abusing or at risk for abusing loperamide.

Thursday, August 1, 2019

Why We Shouldn’t Teach Doctors to be Well

Image Credit: Pexels
Author: Arlene Chung, MD MACM FAAEM
Originally published: Common Sense May/June 2019

My nightmare is waking up to a phone call in the middle of the night with a frantic chief resident telling me that one of our residents is dead.

We shouldn’t be teaching our doctors how to be well. Teaching the individual resident or physician is the easy way out, and as an educator, I do not say that lightly. Culture change is harder, but critical to protecting the wellness of our residents and physicians. Individual wellness education has a place, but increasingly our focus needs to be turned outward toward the places where we can make the greatest impact for both the individual and the system. We must be proactive, not reactive. Once a resident or physician is dead, no amount of after-the-fact education or policy change will bring her back.