These set of lectures is designed to provide important updates in emergency medicine with a focus on anticoagulation and the management of venous thromboembolism as well as bleeding emergencies that may occur in patients on new oral anticoagulants as well as those that present with bleeding peri-procedure. In addition, the relationship between patient safety indicators and quality metrics are discussed both as a separate lecture but also as a theme throughout other lectures – for example, how to approach fluid resuscitation in the context of changing sepsis core measures.
We will review the evolving role of the ED in the diagnosis of HIV and treatment of HIV related illnesses. In addition, a lecture on HCV considers a potential role for the ED in screening and linkage but also on the syndemics of HCV and other disease such as coronary artery disease and diabetes. The colocation of a burgeoning HCV epidemic in young people and the relationship to that epidemic and the ongoing opioid crisis is also discussed. Finally, a quality improvement approach will also be used to consider updated CDC guidelines for the management of STIs.
Opioids are commonly used for pain and opioid rotations are necessary in 20-40% of patients on opioid therapy because of side effects or lack of response. The next generation of conversion metrics will involve opioid utility which looks at risks versus benefits.
Knowing opioid equianalgesia is critically important and utility will help clinicians choose safer opioids. Certain opioids, such as nalbuphine and buprenorphine are finding a niche in pain management and it is important that clinicians know the pharmacology and clinical advantages to both. Methadone dosing has changed and the way it is being used has also been changed and levorphanol is making a come back.
A major issue that has arisen recently is whether cannabinoids should be combined with opioids or gabapentin with opioids. Knowing the pros and cons of these combinations will improve pain management. We have learned much about the long-term potential risks of opioids besides addiction which clinicians should be aware. Difficult pain cases from real life are useful tools to discuss how to manage such problems in a group. Palmitoylethanolamide is a cannabimimetic nutraceutical which is an analgesic for neuropathic pain but also arthritis. There is a rising interest in this agent as an analgesic or adjuvant to standard analgesics.
