Author Archive for: swieters

Noreversaban?

05 Nov
November 5, 2015

Noreversaban?We have written about the new Non-Vitamin K Oral Anti Coagulants (NOACs). Many have jokingly referred to them as the “Noreversabans.” Taking these drugs is a high risk, high reward type of decision. While we recognize the benefits of quick anticoagulation without a need to bridge, as well as being more stable and having less interactions than Coumadin, these drugs are dangerous with serious bleeding concerns. Recently, Dabigatran was likened to “Dancing with the Devil”. For those of us in EM and Critical Care practice, there are no good options for reversing these agents. Once taken there is no turning back… until now?

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Dancing with the Devil: Taking Dabigatran to the OR

31 Aug
August 31, 2015

Dabigatran 2So you are minding your own business working in the ED at Big Hospital, when two dudes (paramedics) bring in a patient with abdominal pain. As luck would have it, this person has a perforated bowel and needs surgery pretty quickly. AND they are on, yes you guessed it… Wait for it… Dabigatran! You consult your local surgeon and she scratches her scrub cap. “I may not want to take that person to surgery? Let me check with my resources and get back…”

If you are like me, you are seeing more and more patients on Dabigatran. This drug is touted to be superior to traditional warfarin for reduction of stroke in atrial fibrillation patients (Ruff 2014) and has had a lot of momentum by many other studies. Read more →

Beyond ACLS: From CPR to Cath – The New ACC/AHA Cardiac Arrest Algorithm

13 Jul
July 13, 2015

Cardiac ArrestSo you are minding your own business when a 60 year old patient comes in after witnessed Out-Of-Hospital Cardiac Arrest (OHCA).  She had a witnessed arrest, good bystander CPR and the prehospital team shocked her out of ventricular fibrillation (vfib), intubated her and brought her in after 25 min of total down time and 15 min of CPR.  She is now neurologically stunned but with a stable blood pressure.  You get an EKG which shows normal sinus rhythm with non-specific ST and T wave changes(NSR NSSTTW changes)  basic labs, and are hunting for a source.  Labs, chest x-ray (CXR), point of care ultrasound (POCUS) by you doesn’t reveal an alternate source to explain the arrest. You start hypothermic protocol and are thinking of sending her to the ICU.  Or maybe not?  What about the cath lab?  Your resident recalls some early data from European studies cathing some of these patients that trended towards favorable results and wants to know how you do things here?  The new ACC guidelines just published this month, July 2015 are here to answer that very question. Read more →

In Criticism Of Praise

11 May
May 11, 2015

In Criticism of PraiseSometimes the most profound academic concepts haven’t come from the wonderful medical conferences or hundreds of academic articles I’ve read, but they come from arenas completely tangential to the medical field.  The topic of this article is a great example of this phenomenon.  It came from of all places, a Southwest Airlines magazine.  It’s titled “In Criticism of Praise” by Heidi Stevens.  Being an optimist with four children and many medical students under my wing, (yes I view them as my children) I was initially offended by the title and it of course, it drew me in. Read more →

Hands-On Defibrillation: If the Glove Fits…You Must Acquit!

27 Apr
April 27, 2015

Hands-On DefibrillationWe’ve had some heated debates on the topic of hands-on defibrillation (HOD) for the past few years. We all know the most important time to avoid a pause during CPR is the perishock pause ((21690495)). We also know that despite lots of safety data ((2302275)(19211180)) and safe experience doing HOD ((18458166), Johnson) there are still concerns over the potential electrical leak using common exam gloves ((22925991), (23507464)(23507465), (23266533)(24992873)). For those who don’t enjoy a little electrical spice in your resuscitations, some recent articles have shown ways in which the safety of HOD can be mitigated using inexpensive tools.

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