Archive for category: Critical Care

February 2017 REBEL Cast: The All Hyperoxia Edition

20 Feb
February 20, 2017

Background: Many providers and health care workers place oxygen on patients as a way to overcome hypoxemia or for patient comfort. Also in STEMI patients, many of us have learned the mnemonic “MONA” to remember the treatments for acute coronary syndrome. MONA stands for morphine, oxygen, nitroglycerin, and aspirin. It is however important to remember […]

Chemical Sedation of the Agitated Patient

16 Feb
February 16, 2017

Background: Acutely agitated and aggressive patients have become an unfortunate commonality in emergency departments throughout the world.  They are often the most difficult patient encounters during a shift. Initially, when these patients’ present, medical providers are trying to figure out the underlying etiology including organic, psychiatric, or drug related illness.  Coaxing agitated patients out of an […]

Intraosseous (IO) Needle Length in Obese Patients

09 Jan
January 9, 2017

Background: 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 […]

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

05 Jan
January 5, 2017

Background: 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 (AHA) guidelines do recommend consideration of […]

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

15 Dec
December 15, 2016

Background: 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 and no STEMI is a bit […]

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