Archive for category: Resuscitation

Sodium Bicarbonate in Cardiac Arrest Management

15 Jun
June 15, 2018

Background: As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s role in patients with acidemia resulting from or causing arrest is unclear. In […]

Dosing Sedatives Low and Paralytics High in Shock Patients Requiring RSI

06 May
May 6, 2018

Background: A series of tweets I sent out recently generated a visceral response from critical care clinicians the world over. I summarized my strategy of shock dose RSI as sedatives low and paralytics high (low dose ketamine, high dose rocuronium along with cardiovascular resuscitative strategies of push dose pressors and peripheral vasopressors). It seems that the visceral response […]

Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over?

28 Feb
February 28, 2018

Background:  Normal Saline (NS) is one of the most commonly used IVFs in resuscitation today.  The use of balanced vs unbalanced crystalloids has been one of the biggest debates in resuscitation of the critically ill in recent history due to concerns of unbalanced fluids causing acute kidney injury, hyperchloremic metabolic acidosis,  and worsened mortality.  In […]

Topics in Post-ROSC Care

29 Jan
January 29, 2018

Background: Post-cardiac arrest patients are among the sickest groups of patients seen in the Emergency Department. They are difficult to study, which leads to endless questions about how to best care for them. Below we address the available evidence on four of these controversies: oxygen therapy, hemodynamic management, cardiac catheterization and head CT. We recognize […]

REBEL Cast Ep 44: IO vs IV in Out-of-Hospital Cardiac Arrest (OHCA)

25 Jan
January 25, 2018

Background: Placement of vascular access for administration of resuscitation drugs and fluids is a common procedure in the management of out of hospital cardiac arrest (OHCA). While intravenous (IV) placement has been the standard approach for decades, intraosseous (IO) access is rapid and safe and may be the preferred approach due to fact that the bone […]