Author Archive for: robbryant13

Abscess Management: The Reformation of an Antibiotic Nihilist

12 May
May 12, 2018

Abscess management has evolved somewhat in the 14 years since my residency graduation. The point at which antibiotics are likely to be more helpful than harmful is not always easy to assess, and evidence based expert opinion has flip flopped impressively.

Based on current evidence, I would like to answer 3 big questions that every clinician may have when confronted with an abscess:

  1. Who needs antibiotics?
  2. Which abscesses need to be drained?
  3. How should abscesses be drained?

Read more →

Peri-Intubation Anaphylaxis

08 May
May 8, 2017

Background: Peri-operative anaphylaxis is an unexpected complication of intubation. The major life threat in anaphylaxis is typically loss of airway, however profound hypotension and circulatory collapse are still possible life threats even in the setting of a protected airway. Peri-operative anaphylaxis is considered an important enough issue to be the subject of the NAP 6 (National Audit Project) audit this year in Great Britain.  (Reporting period November 2015 – November 2016). Read more →

Post Intubation Hypotension: The AH SHITE mnemonic

20 Apr
April 20, 2017

You have just secured the endotracheal tube following an uneventful intubation of a moderately ill  patient in your emergency department. They had a normal pre-intubation blood pressure.  As you are calling the admit in to the ICU the patient’s nurse tells you that the BP is now in the 70’s.

NOW WHAT?

  1. Blindly give a half gallon of saline and stay in your seat.
  2. Get up, walk to the patient’s room, and consider the possible causes of post intubation hypotension.

Read more →

Altitude Adjusted PERC Oxygen Saturation

27 Mar
March 27, 2017

The PERC rule has been a welcome addition to the emergency department evaluation of patients with chest pain or dyspnea suspected of pulmonary embolism. This has allowed a reduction in D-dimer testing in low risk patients. The traditional saturation cut-off of 95% can pose a challenge for patients seen at higher elevations where mild hypoxemia can be a normal physiologic parameter. At these elevations patients can flunk the PERC rule due to borderline hypoxemia with oxygen saturation levels in the 93-94% range, despite  all other PERC rule criteria being negative. This can result in D-dimer testing and the associated risk of unnecessary CT radiation exposure in the event of a false positive D-dimer.

Read more →

How to Call a Consult

17 Mar
March 17, 2016

How to Call a ConsultWhen on shift in the ED we spend more time with a phone in our hand than a laryngoscope. Despite this, we spend a lot more time finessing our laryngoscopy skills than the way we call our consults. Calling an efficient and effective consult / admit can greatly improve our on-shift flow, and therefore happiness. The rest of this post will focus on the art of how to call a consult. Read more →

Optimization WordPress Plugins & Solutions by W3 EDGE