controversial EM topics

[jumponit]

---

Members don't see this ad.

hey guys,

it's that time of year again, and I've got my junior presentation coming up, I wanted to pick everyone's brains on the newest and hottest topics in EM.

Does anyone have any recommendations on what would be a good/controversial topic for an EM presentation? It will be in front of residents and attendings alike and I'd like someone engaging for the audience.

thanks!

 

[deleted109597]

tpa
Antibiotics for ear, throat, and upper respiratory infections
Working up htn
digital epi

Xaelia had a thread on all of these and more last year.

 

[deleted6669]

propofol- who decides if the ed providers can use it
tpa for stroke- what is the real time window or are we all just pawns of genentech
role of pa's and np's in emergency medicine
the joint commission-worth the trouble or should we opt out?
press ganey/etc
best em role in critical care and trauma-are there procedures we should be doing but aren't ( some advocate for em docs to get training in angioplasty for use at rural ctrs for example)
aeromedical services- worth the risk?
ems- doing too much or not doing enough
non-em boarded docs in em jobs/ "alternate pathway" to em board certification BCEM
community em program vs county em program for residency- which puts out better grads?

 

[xaelia]

Let's see what was on my list....

- vasopressors, does making the number look better actually improve outcomes?
- do any of our commonly prescribed muscle relaxants actually work?
- advantages/disadvantages to intraosseus lines
- do abscesses need packing? or antibiotics?
- does cellulitis without an abscess really need MRSA coverage?
- are massive transfusion protocols necessary?
- steroids in spinal cord trauma (something our neurosurgeons frequently do that's way behind the times)
- tpa
- digital rectal examination (in trauma, in undifferentiated abdominal pain)
- early goal-directed therapy for sepsis
- CT contrast risks
- pitfalls of CT coronary angiography (too many false positives)
- efficacy of in-house rapid response teams (function mostly just to move people to the ICU to die)
- utility of lidocaine in head injury (no)
- "defasciculating dose" in intubation
- sux vs roc (why ever use sux for RSI?)
- etomidate vs anything (versed, ketamine) for RSI in sepsis
- utility (false positives, change in treatment) of urine/blood/wound cultures
- "seatbelt signs" and who to scan
- absorbable vs nonabsorbable suture
- any element of acls
- is droperidol's black box warranted
- does laceration repair need to be "sterile"
- why would you ever use ketorolac vs ibuprofen

And many more.

www.thennt.com has some more ideas that are a little bit more farfetched - like the efficacy of heparins in NSTEMI, which I think might be validated a little bit by the retrospective subgroup analysis from the ACUITY trial where it didn't matter how soon you started heparin for NSTEMI in terms of preventing additional events. I.e., if it doesn't matter how quickly you start a treatment, then maybe the treatment isn't doing anything....

 

[joeDO2]

elimination of DL in favor of VL as first line for emergency intubations

 

[jumponit]

Thanks everyone, a lot of great topics. I may just have to incorporate a handful of them together, with a common theme.

Any other ideas welcome too!

 

[rocuronium]

Hypoxic drive and oxygen therapy in COPD patients.

 

[deuist]

* Packing for abscess
* Abx for abscess
* GI lavage for LGIB
* Rectal exams for occult GI blood loss

 

[Rendar5]

permissive hypotension in trauma or whatever the term is nowadays (if you cover this may as well also cover massive transfusion protocols).

sux vs roc (why ever use sux for RSI?) -- as an aside to xaelia, I had an interesting case a few months back. went to intubate a guy for failure to protect airway, used succ, and found a completely malformed epiglottis that was actually blocking the path to the cords. multiple attempts by me and attending with a variety of techniques, we stopped, let the succ wear off and had anaesthesia come in to attempt. Turned out he had been run over by his ex-wife the year before (multiple times) Took anaesthesia at least 45 minutes to get the tube in with 2 providers working on it. Hate to think how long we'd have been bagging him if we had RSI'd with roc (which is what I had actually wanted to use, but the attending thought otherwise). Though truth be told don't think I'll see one of those cases again in my career.