Background: Epinephrine(adrenaline) has been used in advanced life support in cardiac arrest since the early 1960s. Despite the routine recommendation for its use, evidence to support administration is less than ideal. Although it is clear from multiple observational studies that epinephrine improves return of spontaneous circulation (ROSC) and short-term survival, most evidence suggests an absence of improvements in survival with good neurologic outcomes. In cardiac arrest we want to take advantage of the alpha effects of epinephrine, including peripheral vasoconstriction, and therefore increasing aortic diastolic pressure, which in turn helps augment coronary and cerebral blood flow. On the other hand, we want to avoid the potentially detrimental beta effects including dysrhythmias, decreased microcirculation, and increased myocardial oxygen demand all of which increase the chances of recurrent cardiac arrest and decreased neurologic recovery. The only two interventions in cardiac arrest that have shown improve survival with good neurologic outcomes continue to be high-quality CPR and early defibrillation. The debate over the utility of epinephrine in OHCA has been ongoing for several years now and many providers have been awaiting the results of the PARAMEDIC-2 trial that was just published in the NEJM 2018. Read more →
Neutropenia: An absolute neutrophil count less than 500 cells/mm3 or less than 1000 cells/mm3 with a predicted decline to less than 500 cells/mm3
ANC = WBC x (neutrophil% + band%)
- Mild: 1000 – 1500
- Mod: 500 – 1000
- Severe: 100 – 500
- Profound: <100
Have you ever heard an entire lecture on sinus tachycardia? Neither have I. It is the most common cardiac dysrhythmia seen in critically ill adults and kids, but it is the least frequently talked about. Sinus tachycardia may not be the sexiest rhythm and we don’t think of cardioverting it or giving some new anti-arrhythmic drug, but it is a sign that something may be seriously wrong. To be fair, it’s not the sinus tachycardia we are really worried about, but rather what’s causing the sinus tachycardia that should be our main concern. Read more →
The 1stannual Rebellion in EM Clinical Conference took place in San Antonio, TX on May 11th– 13th, 2018. If you missed out in 2018, the Rebellion is coming back June 28th – 30th, 2019. Stay up to date as we plan the conference for this upcoming year at www.rebellioninem.com.
The Missions of Rebellion in EM:
- Decrease Knowledge Translation: With 100s of journals and thousands of publications every year, it takes time for research to disseminate to clinical practice. Discussion of current literature and its application to practice is the key to facilitating safe best practices.
- Create a Community of Practice: It requires many to take care of the few. Patient care is a team sport that starts pre-hospital, continues through the ED, and finally into the hospital.
- Improve Patient Care: Decrease suffering and improve patient oriented outcomes
“Learning is always rebellion…every bit of new truth discovered is revolutionary to what was believed before.” -Margaret lee Runbeck- Read more →
Background: Focused use of ultrasound in resuscitation of patients with shock and cardiac arrest has become increasingly embraced in both the emergency department (ED) as well as in the prehospital setting. Application of ultrasound, particularly of echocardiography, has the potential to identify treatable causes of shock and arrest, identify shockable rhythms and identify the presence of mechanical activity. All of these can affect management decisions and, potentially effect outcomes. Recent studies have led to concerns that integration of point of care ultrasound (POCUS) in cardiac arrest increases pauses in compressions. Thus, it is important to establish what POCUS adds to shock and arrest management. Read more →