Archive for category: Critical Care

Intraosseous (IO) Needle Length in Obese Patients

09 Jan
January 9, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: 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 […]

The PEAPETT Trial: Half Dose tPA for PEA due to Massive Pulmonary Embolism

05 Jan
January 5, 2017

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Anyone who has run a code, knows that pulseless electrical activity (PEA) during cardiac arrest has a worse prognosis compared to patients with shockable rhythms.  In patients with suspected massive PE as the cause of their cardiac arrest the Advanced Cardiac Life Support (ACLS) and American Heart Association […]

Cardiac Arrest, Return of Spontaneous Circulation (ROSC) With No ST-Segment Elevation on ECG. Now What?

15 Dec
December 15, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: The American Heart Association/American College of Cardiology (AHA/ACC) give a Class I recommendation for activation of the cardiac catheterization lab in patients with out-of-hospital cardiac arrest (OHCA) whom ST-segment elevation myocardial infarction (STEMI) is present.  The evidence for early cardiac catheterization in patients after cardiac arrest, with ROSC […]

The REASON Trial: POCUS in Cardiac Arrest

08 Dec
December 8, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: For many emergency providers, POCUS has become a critical modality in the resuscitation of patients with cardiac arrest. The authors of this paper (The REASON Trial) state that <8% of all OHCA’s survive to hospital discharge; a dismal number.  We already know that shockable rhythms, early defibrillation, early […]

Does Targeted Temperature Management Actually Work?

28 Nov
November 28, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketThe use of therapeutic hypothermia (TH) has become part of the routine care of patients after return of spontaneous circulation (ROSC) from cardiac arrest (Use of the phrase Targeted Temperature Management has become more accepted). It became much more accepted after two separate trials were published in the New […]

The HYPRESS Trial: Early Steroids to Prevent Septic Shock

31 Oct
October 31, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: The most recent surviving sepsis campaign recommends the use of hydrocortisone in patients with refractory septic shock (i.e. vasopressor dependent).  However, the use of hydrocortisone in severe sepsis without shock still remains a very controversial topic. Recommendations for hydrocortisone are mostly based on 2 randomized clinical trials (i.e. […]

Baclofen Withdrawal

27 Oct
October 27, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketDefinition: A dysfunctional condition in which removal of baclofen, an inhibitory neurotransmitter, from the central nervous system (CNS) causes CNS excitation.

The PESIT Trial: Do All Patients with 1st Time Syncope Need a Pulmonary Embolism Workup?

24 Oct
October 24, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Syncope is a very frustrating chief complaint for many in the medical field.  There is no gold standard test and no validated decision instrument. It represents about 3 – 5% of ED visits, 1 – 6% of hospital admissions, and in patients over the age of 65 years […]

American College of Emergency Physicians (ACEP) Conference 2016

20 Oct
October 20, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketThis years ACEP 2016 conference took place in Las Vegas, NV from Oct 16th – 19th.  There was greater than 350 courses, labs, and workshops given throughout the week.  It was impossible to make all of these great lectures, but I was able to take away some very important […]

Hyperthermia Syndromes

17 Oct
October 17, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketDefinition: 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 […]

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