Author Archive for: Swami

Intraosseous (IO) Needle Length in Obese Patients

09 Jan
January 9, 2017

intraosseousBackground: Intraosseous (IO) access can play an important role in the resuscitation of the critically ill patient to help expedite delivery of critical medications (i.e. RSI). Much like with peripheral or central access, obesity can present a challenge to placement of an IO as accurate placement relies on use of landmarks which may not be palpable in this group. Additionally, increased soft tissue depth may render standard needles ineffective. IO needles require 5 mm of excess length from skin to bony cortex to ensure successful placement (i.e. maximal depth of 20 mm for a 25 mm needle). Studies investigating these questions are necessary in order to understand how reliable IO access will be in obese patients. Read more →

Baclofen Withdrawal

27 Oct
October 27, 2016

Baclofen WithdrawalDefinition: A dysfunctional condition in which removal of baclofen, an inhibitory neurotransmitter, from the central nervous system (CNS) causes CNS excitation. Read more →

Hyperthermia Syndromes

17 Oct
October 17, 2016

hyperthermia-syndromesDefinition: A life-threatening emergency in which there is a failure of the body’s thermoregulatory mechanisms to handle extrinsic and intrinsic heat. The failure of thermoregulation leads to multi-system organ dysfunction characterized by alteration of neurologic function. Unlike in fever, hyperthermia is not caused by endogenous pyrogens that change the thermoregulation set point in the brain. Hyperthermia results from excessive heat production and/or inadequate heat dissipation Read more →

October 2016 REBEL Cast: IDSA Pneumonia Update

10 Oct
October 10, 2016

pneumoniaEvery few years we get updates in the guidelines based on new evidence. Guidelines give us a framework to work with in the treatment of disease processes, such as pneumonia. The last Infectious Disease Society of America (IDSA) guidelines update on the treatment of pneumonia came from 2005, but recently, the new 2016 guidelines were just published. This was a massive 51 page summary that starts off by saying:

“It is important to realize that guidelines cannot always account for individual variation among patients.  They are not intended to supplant physician judgment with respect to particular patients or special clinical situations.  IDSA considers adherence to these guidelines to be VOLUNTARY, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.” Read more →

Single Dose Dexamethasone or 5 Days of Prednisone in Adult Asthmatics?

11 Aug
August 11, 2016

Single Dose DexamethasoneBackground: Acute asthma presentations account for more than 2.1 million Emergency Department (ED) visits annually. In the US, 8.4% of the population is affected by the disease. Current guidelines from the National Heart, Lung, and Blood Institute recommend a minimum of 5 days of oral prednisone to treat moderate to severe asthma exacerbations (NHLBI Guidelines 2007). Oral and parenteral dexamethasone have similar bioavailability, with a duration of action of 72 hours. There has been promising data on dexamethasone for acute asthma from the pediatric literature, as well as a 2-dose regimen in adults. However, due to the strong association with low patient adherence and poor outcomes, a single dose of a long acting oral medication in the ED may help prevent relapse of symptoms. Read more →

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