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What's Hot in Emergency Medicine June 2018

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What's Hot in Emergency Medicine June 2018

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What's Hot in Emergency Medicine June 2018

  1. 1. What’s hot in EM? Dr F Morris Education Registrar
  2. 2. Overview • Hot legs – Imaging and blood cultures in cellulitis • Clot disposal – PE pathway 2018 • Recognising the deteriorating sepsis guideline • Haematologists party hard – Anticoagulant nomenclature
  3. 3. Cellulitis “Let’s get some pictures of that leg”
  4. 4. • Retrospective cohort study • Oct 2014 – Feb 2017 • n = 183 “uncomplicated cellulitis” – Admitted to medics or EDU. – 60 had blood cultures – 1 positive growth • 18/183 were appropriate by IDSA guidelines. – 124 had imaging: • 83 had 1 form; 30 had 2 forms; 11 had 3 or more forms. • All were inappropriate by IDSA guidelines. • Higher proportion of chronic lymphoedema and diabetes. Ko LN et al. Clinical usefulness of imaging and blood cultures in cellulitis evaluation. JAMA Intern Med 2018 Apr Stevens et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014
  5. 5. Clinical Resources Efficiency Support Team (CREST). Guidelines on the management of cellulitis in adults. June 2005
  6. 6. Pulmonary Embolism
  7. 7. Palliating the SSC
  8. 8. Surviving Sepsis Campaign 2018 • Combines 3-h and 6-h bundles into 1-h bundle Levy et al. The Surviving Sepsis Campaign Bundle: 2018 Update.
  9. 9. Surviving Sepsis Campaign • Conflicts of interest • Arbitrary and dangerous – Strong recommendations on weak evidence – Hasty management decisions – Inappropriate fluid administration – Indiscriminate use of broad spectrum Abx • Hegemony/Monopoly • Stagnation and dogmatism
  10. 10. No One (in ED) Actually Cares
  11. 11. HEPARIN WARFARIN RIVAROXABAN DABIGATRAN APIXABAN BIVALIRUDIN EDOXABAN
  12. 12. International Society on Thrombosis & Haemostasis NOAC ODI DOAC SODA TSOAC NVKAOAC Barnes GD, Ageno W, Ansell J, Kaatz S, for the Subcommittee on the Control of Anticoagulation. Recommendation on the nomenclature for oral anticoagulants: communication from the SSC of the ISTH. J Thromb Haemost 2015; 13: 1154–6.
  13. 13. Summary • Think about your tests in cellulitis • New PE pathway (via scghed.com) • Sepsis is still causing a fuss • We can still use the term NOAC

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