EM Quick Hits 1 Massive PE, Gabapentin for Alcohol Withdrawal, Dental Avulsions, Pediatric Eye Exam, Best Resuscitation Fluid

Topics in this EM Quick Hits podcast Anand Swaminathan on priorities in massive pulmonary embolism management (0:54) Michelle Klaiman on gabapentin for alcohol withdrawal (7:31) Hans Rosenberg on management of dental avulsions (13:47) Anna MacDonald on approach to the pediatric eye exam (19:00) Justin Morgenstern on normal saline vs balanced fluids (26:45) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Anand Swaminathan, Michelle Klaiman, Hans Rosenberg, Anna MacDonald & Justin Morgenstern, edited by Anton Helman, January 2019 Cite this podcast as: Helman, A. Swaminathan, A. Klaiman, M. Rosenberg, H. MacDonald A, Morgenstern J. EM Quick Hits 1 - Massive PE, Gabapentin for Alcohol Withdrawal, Dental Avulsions, Pediatric Eye Exam, Best Resuscitation Fluid. Emergency Medicine Cases. January, 2019. https://emergencymedicinecases.com/em-quick-hits-january-2019/. Accessed [date]. Priorities in massive pulmonary embolism management Massive PE is a true life threat. These patients will die and will die quickly if you don’t act; so get moving. You don’t need a CT to pull the trigger on treatment - think about what else could cause the clinical scenario and master POCUS to quickly eliminate these causes and gain supporting evidence of PE (see Rob Simard's video POCUS Cases 1 - POCUS for PE) If the patient has PE with hemodynamic compromise or collapse, consider thrombolytics but don't forget the other things; start a vasopressor for hemodynamic support and avoid fluids whenever possible. We don’t know the right dose of lytics so tailor to the patient in front of you. If the patient is in cardiac arrest, use 50mg alteplase or tenecteplase as an initial dose. Expand to view reference list REBEL EM: The Critical Pulmonary Embolism Patient PulmCrit: Controlled Thrombolysis of Submassive PE Wan S et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004; 110(6): 744-9. Wang C et al. Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multi center, controlled trial. Chest 2010; 137(2): 254-62. Gabapentin for alcohol withdrawal * Benzodiazepines are first line therapy for acute alcohol withdrawal in the ED (deep dive on Episode 87 Alcohol Withdrawal and Delirium Tremens). * Once patients are loaded with benzodiazepines and withdrawal symptoms are controlled, no outpatient prescription for benzodiazepines is required. * Gabapentin is at least as effective as lorazepam for acute alcohol withdrawal, but there is not enough data to support its use as monotherapy. * Rather than providing an outpatient prescription for benzodiazepines,