Congratulations to all of the authors with the most popular posts of 2021!
1. Pill in the Pocket (23,646 views)
The runaway favorite of this year was Dr. David Feiger’s (NUEM ’22) and Dr. Jon Andereck’s (NUEM ’19) post reviewed by Dr. Kaustubha Patel of Northwestern's Bluhm Cardiovascular Institute about the “pill-in-the-pocket” approach to treating atrial fibrillation.
Take-Home Point: In select patients, the “pill-in-the-pocket” approach is a safe and effective way to treat infrequent but symptomatic paroxysmal atrial fibrillation that reduces ED visits and improves patients’ quality of life.
2. Peripheral Vasopressors: Do I need that central line? (8,683 views)
In the second most popular blog of the year, Dr. Saabir Kaskar (NUEM '23) and Dr. Abiye Ibiebele (NUEM '21), with commentary by Northwestern pulmonologist/intensivist, Dr. Marc Sala, summarize the current literature on the peripheral infusion of vasopressors, which is becoming more and more commonplace as the evidence evolves to support earlier initiation of pressors and more judicious use of crystalloid for many forms of shock.
Take-Home Point: While the evidence at this time is limited, clinicians should feel comfortable administering peripheral vasopressors as a bridge to central infusion for a limited time. Peripheral vasopressors have a lower risk of complications than previously thought and allow clinicians to minimize delays in administering vasoactive medications that may have a mortality benefit.
3. Pericardiocentesis (2,553 views)
Rounding out the top three is Dr. David Feiger's (NUEM '22) and Dr. Abiye Ibiebele's (NUEM '21) post on emergent pericardiocentesis, a potentially life-saving procedure in a patient with hemodynamically significant cardiac tamponade, with expert commentary by Northwestern interventional cardiologist, Dr. Dan Schimmel.
Take-Home Point: Bedside pericardiocentesis is a rare but important procedure that can be performed emergently using ultrasound or landmark guidance. While a subxiphoid approach is commonly performed, an apical or parasternal approach may be considered to minimize potential complications. Consider exchanging the needle for a drain once the pericardium is accessed to bridge to definitive therapy.
4. Hanging Injury (959 views)
Dr. Vytas Karalius (NUEM '22), Dr. Nery Porras (NUEM '21), and expert commentator Dr. Kevin Emmerich describe the mechanisms of injury and management of patients presenting with hanging injuries, an unfortunate but all-too-common method of self-harm worldwide.
Take-Home Point: Hanging injuries can have wide-ranging immediate and delayed complications on multiple organ systems and clinicians should evaluate for cervical spine and cerebrovascular injury and anticipate a difficult airway due to evolving airway edema. Clinicians should have a high index of suspicion for polytrauma or toxic ingestion. Even with an initial negative workup, all patients should be admitted for observation (with a low threshold to transfer to a trauma center) and ultimately a psychiatry consult.
5. Paronychia (623 views)
In one of two procedural infographics to make the top ten this year, Dr. Richmond Castillo (NUEM '23), Dr. Andra Farcas (NUEM '21), and Dr. Matthew Kippenhan provide a visual guide to diagnosing and treating a common "fast-track" complaint.
Take-Home Point: Paronychia is a common infection of the nail fold that often requires an incision and drainage procedure if a purulent fluid collection is present. Be wary of several other "can't miss" visual diagnoses on the differential, such as herpetic whitlow, felon, and proximal onychomycosis.
6. Antiemetics/Gastroparesis (572 views)
With expert commentary by NUEM faculty Dr. Howard Kim, Dr. Nery Porras (NUEM '21) and Dr. Terese Whipple (NUEM '20) provide an overview of the role of antipsychotics in the treatment of gastroparesis and other cyclic vomiting syndromes. These conditions can be difficult to treat, frustrating for both patients and providers, and refractory to traditional antiemetic therapies.
Take-Home Point: Antipsychotic medications such as haloperidol and droperidol are effective therapies for nausea, vomiting, and abdominal pain associated with gastroparesis. Despite previous black box warnings on droperidol causing it to fall out of favor, it is safe and well-tolerated at the doses typically used in an emergency department setting.
7. Basic Capnography Interpretation (560 views)
Dr. Shawn Luo (NUEM '22) and Dr. Matthew McCauley (NUEM '21) review the basics of interpreting continuous waveform capnography, a versatile tool with multiple uses in both the emergency department and critical care settings. Dr. Seth Trueger, NUEM faculty, provides expert commentary.
Take-Home Point: Continuous waveform capnography (otherwise known as end-tidal CO2) is a valuable tool that can inform real-time management decisions in both intubated and non-intubated patients. Recognizing several common patterns can guide providers during several use-cases such as confirming endotracheal tube placement, cardiac arrest, and procedural sedation.
8. Knee Dislocation (436 views)
Knee dislocations are a rare but highly morbid condition for which Dr. Andrew Rogers (NUEM '22) and Dr. Amanda Randolph (NUEM '21) provide a streamlined approach to diagnosing and treating. NUEM's own emergency orthopedic guru, Dr. Matthew Levine, provides expert commentary.
Take-Home Point: Knee dislocations are time-sensitive injuries that require rapid diagnosis and treatment because of the high rate of vascular complications. Emergent closed reduction is key, with a thorough neurovascular exam before and after. All patients require ABIs (with CT angiography if the ABI is abnormal) and admission for neurovascular checks. Speak with your consultants early.
9. TPA in Frostbite (422 views)
For those who practice in colder climates, Dr. Patrick King's (NUEM '23) and Dr. Nery Porras's (NUEM '21) review of the current literature on the role of tPA in frostbite is timely as we enter into the winter season. Expert commentary is provided by Dr. Anne Lambert Wagner, medical director of the Burn and Frostbite Center at the University of Colorado Health.
Take-Home Points: While literature continues to evolve, current evidence supports the use of tPA in select patients with severe frostbite injuries in multiple digits, multiple limbs, or proximal limb segments presenting within 24 hours of injury. Combined with active rewarming strategies, tPA use results in significantly improved outcomes.
10. Felon (381 views)
Rounding out the top 10 for 2021 is the second procedural infographic, which is closely related to our Paronychia post. The expert review of Dr. Matthew Levine, Dr. Daniel Levine (NUEM '23), and Dr. Will LaPlant (NUEM '20) illustrate the diagnosis and management of felons in the emergency department.
Take-Home Point: Understanding finger anatomy is key to understanding felons, which present as tense, throbbing, purulent infections of the distal finger pad. Incision and drainage is the mainstay of therapy for felons, with a course of oral antibiotics and mandatory hand surgery follow-up to avoid complications such as flexor tenosynovitis or osteomyelitis of the distal phalanx.