Author Archive for: srrezaie

Video Laryngoscopy (VL) Or Direct Laryngoscopy (DL) in the ED

12 Apr
April 12, 2018

Background:Endotracheal intubation is a common occurrence in the ED. Many patients requiring airway management are at a higher risk of hypoxia due to deranged respiratory physiology (i.e. decreased functional residual capacity and/or increased shunt fraction).  Advocates of video laryngoscopy argue that it provides better visualization of the airway anatomy, but it is less clear if better visualization correlates with better patient oriented outcomes. Good preparation, pre-oxygenation, and having a plan A, B, and C prior to intubation are essential requirements in 1st pass intubation success rate and decreased intubation time.  What is less clear is should plan A be VL or DL? Read more →

The PARIS Trial: HFNC in Infants with Bronchiolitis

09 Apr
April 9, 2018

Background: Bronchiolitis is an acute inflammatory injury of the distal smaller airways, most commonly caused by viral infections.  There have been a host of medications studied in the treatment of bronchiolitis, including steroids, albuterol, epinephrine, and  inhaled hypertonic saline, with none proving to be effective in treatment.  Oxygen therapy via high-flow nasal cannula (HFNC) as opposed to standard nasal prongs provides some positive airway pressure which decreases work of breathing, improves oxygenation, and rates of intubation.  The trial we are going to review today (The PARIS Trial) evaluated early high-flow oxygen therapy vs standard oxygen therapy in infants with bronchiolitis and hypoxemia in both the emergency department and general pediatric ward settings. Read more →

Presentation Design: A Picture is Worth 1000 Words & Better Evaluations?

05 Apr
April 5, 2018

Background: Lectures are the most common education form at medical conferences. For simplicity sake, generally, the lecturer stands in front of a group of learners and disseminates information via the use of slides. Learning theories, such as Mayer’s cognitive theory of multimedia learning, have shown that learners can either process visual or auditory information but not both simultaneously. Additionally, this processing is finite. One of the key lessons in presentation design, from psychological theories of learning, is to replace text with visual representations while the presenter tells a story.  This has also been shown to help improve retention of knowledge [2,3].  Most of the studies that show this are supported by medical student classroom learning environments. Little research has been performed in adult learning environments. Read more →

APROCCHSS: More on Steroids in Septic Shock

29 Mar
March 29, 2018

Background: There have now been several trials published on the use of steroids in sepsis.  In 2002, we had the Annane Trial, with 299 patients showing mortality and shock reversal benefit in sepsis with hydrocortisone.  Then in 2008 we had the CORTICUS trial, with 499 patients, which found a faster reversal of shock, but no benefit in mortality.  Next the HYPRESS trial published in 2016 with 380 patients, with severe sepsis, not septic shock,  showed no difference in mortality or time to reversal of shock.  And finally the ADRENAL Trial published this year with 3800 patients show no difference in mortality, but a small benefit in reversal of shock.  Due to these mixed results, many physicians have variable practice patterns with the use of steroids in sepsis/septic shock.  Now, we have the APROCCHSS trial looking at hydrocortisone plus fludrocortisone for adults with septic shock (By the way the lead author is the same author that published the 2002 steroids in sepsis trial…Annane). Read more →

REBEL Cast Ep 47: Blood Transfusions, Lidocaine for Kidney Stones, and Stop Using So Much Oxygen

26 Mar
March 26, 2018

Background: Welcome back to REBEL Cast episode 47.  In this issue we are going to talk about some recent trials published in the past year that have gotten some love in the FOAMed world.  We have been meaning to discuss these trials, but just simply didn’t have the time until now.  What trials are we reviewing?

  • The age of PRBCs in transfusion
  • The usefulness of lidocaine in renal colic
  • The utility of oxygen therapy in Stroke

Read more →

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