Author Archive for: Swami

Succinylcholine or Rocuronium for 1st Pass Success Rate

08 Jun
June 8, 2018

Background: Administration of a neuromuscular blocker (NMB) is an essential part of Emergency Department  (ED) airway management for facilitating ideal airway conditions and is most commonly performed with either succinylcholine or rocuronium. Despite extensive debates between providers, one agent has not been shown to be superior to other. Limited anesthesia literature has shown that succinylcholine may provider better intubating conditions but it has a number of contraindications (which may not be initially apparent)(Shoenberger 2018). Rocuronium at high doses has a similar onset of action to succinylcholine and may provider longer safe apneic times (Swaminathan 2018). This study seeks to add more information to the clinical discussion. Read more →

Tenecteplase versus Alteplase before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK)

04 Jun
June 4, 2018

Background: Alteplase is a tissue plasminogen activator that is approved for use prior to thrombectomy in ischemic strokes with the goal of reperfusion to ischemic areas of the brain. Tenecteplase is a recombinant enzyme derived from alteplase that is more specific to fibrin and more resistant to inactivation by alteplase inhibitors. Tenecteplase is less expensive, can be administered at a faster rate than alteplase and has a longer half-life allowing for bolus dosing. Prior studies have shown similar to better outcomes with use of tenecteplase versus alteplase in patients with ischemic stroke. Read more →

Cauda Equina Syndrome

31 May
May 31, 2018

Definition: Syndrome characterized by dysfunction of multiple lumbar and sacral nerve roots in the lumbar vertebral canal due to compression

Anatomy

  • The spinal cord terminates in the conus medullaris at the T12/L1 vertebral body in adults
  • Cauda equina
    • Collection of nerve roots from L1-S5
    • Compression from various causes results in lower motor neuron pathology

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Penetrating Neck Injuries

28 May
May 28, 2018

Background: Patients with penetrating neck trauma can present with a variety of injury patterns including hemorrhagic shock, airway obstruction and neurologic injury. Serious injuries may not be clinically obvious making diagnosis and prompt treatment challenging. Due to the large number of critical structures in the neck, a clear knowledge of the anatomy is necessary for proper evaluation and management.

Epidemiology (Evans 2018)

  • Represent 1% of all trauma admissions in the US and have a 5% mortality rate
  • 80% of morality secondary to cerebral infarction
  • ~ 20% of mortality secondary to uncontrolled hemorrhage

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Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis

24 May
May 24, 2018

Background: Sore throat is among the most common complaints in the emergency department (ED). Sometimes, the etiology is bacterial, and in those cases antibiotics may shorten the duration of disease and provide symptomatic relief. The majority of cases are viral and though most are appropriately treated with symptom management in the forms of NSAIDS and acetaminophen, some are prescribed antibiotics before cultures result in the hopes of alleviating pain. Corticosteroids are another treatment modality with prior studies suggesting their effectiveness. That said, steroids remain an uncommon therapy for a common disease. Read more →

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