Archive for category: Clinical

The ADRENAL Trial: Steroids in Septic Shock

22 Jan
January 22, 2018

Background: Randomized clinical trials evaluating the efficacy of adjunctive corticosteroids in septic shock have shown conflicting evidence of clinical relevance. Two trials in particular [2][3] looked at lower dose hydrocortisone (200mg/day) and its effect on mortality in patients with septic shock resulting in conflicting results in regards to mortality, but both showing earlier reversal of […]

Should we Pump up the Juice (Steroids) in Septic Shock?

18 Jan
January 18, 2018

Background: A Cochrane review was published in 2015 evaluating 33 trials with 4,268 participants to evaluate the effects of corticosteroids on death at one month in patients with sepsis.  In that meta-analysis the authors concluded that despite the overall low quality of evidence, corticosteroids still reduced mortality among patients with sepsis. Corticosteroids in sepsis/septic shock […]

Post-Partum Hemorrhage

15 Jan
January 15, 2018

Definition: Blood loss > 500 ml after a delivery (or > 250 ml after an abortion). The management of post-abortion hemorrhage is similar to that of post-partum hemorrhage (PPH). Causes Uterine atony (~ 50% of cases) Retained products of conception (POCs) Cervical lacerations Uterine perforation Uterine Inversion Abnormal placentation (accreta, increta, percreta) Coagulopathy Background: Occurs […]

REBEL Cast Ep 43: Pain Control and Opioid Sparing Options in the ED

08 Jan
January 8, 2018

Background: In the United States we are not only seeing an opioid epidemic but also a shortage of IV opioid agents. For both reasons, it is important to find non-opioid options for common pain complaints seen in the ED.  Changing prescribing practices is difficult but an important step in minimizing opioid usage.  Current research suggests […]

Effect of POCUS in Cardiac Arrest on Compression Pauses

14 Dec
December 14, 2017

Background: The provision of high-quality compressions with minimal interruptions is central to the management of cardiac arrest. Along with defibrillation, high-quality compressions are the only interventions proven to improve patient-oriented outcomes. Recently, point-of-care ultrasound (POCUS) has gained greater use in cardiac arrest care for determination the cause of arrest as well as guiding the resuscitation and […]

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