Welcome back to the April 2016 edition of REBELCast. For this episode I was lucky enough to get Scott Weingart on the show to talk to us about all things Apneic Oxygenation (ApOx). ApOx is a concept that has been around for some time in the operating room literature, but only recently been gaining acceptance in the ED, especially after the publication of this concept by Scott and Richard Levitan in the Annals of Emergency Medicine in 2011 . Many nay sayers will argue that the OR studies were in controlled settings with elective surgical patients who were not in critical condition. The believers would argue that ApOx makes sense, its low cost, and low complexity. To date there has been no randomized controlled trials (RCTs) on ApOx in the ED. There has been one ICU Trial (i.e. The FELLOW Trial)  and an even more recent observational trial in the ED  that have been published on the topic of ApOx. So the question remains: Is Apneic Oxygenation Overhyped? Read more →
So this is the second installation of Advice to Graduating Residents. Again, many 3rd year residents will be graduating in just a few short months and taking on their first jobs as attending physicians. I was lucky enough to sit down with the amazing Amal Mattu and pick his brain. He gave some valuable words of wisdom, which I will try and summarize in this post, but for the full advice, be sure to checkout the podcast. Read more →
Post Written By: Sam Ghali (Twitter: @EM_RESUS)
In cardiac arrest care there has been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why? Because we know interruptions are bad [1,2]. One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival [3,4].
Background: Currently the Advanced Trauma Life Support (ATLS) guidelines recommend initial treatment of decompression of a tension pneumothorax, as needle thoracostomy (NT) using a 5cm angiocatheter at the 2nd intercostal space (ICS2) in the mid clavicular line (MCL). With the growth of size in our population worldwide, there has been increasing evidence about two things:
- A 5cm angiocatheter may not be long enough to reach the pleural space
- The 2nd intercostal space at the mid clavicular line (ICS2-MCL) may not be the ideal location for needle decompression
When on shift in the ED we spend more time with a phone in our hand than a laryngoscope. Despite this, we spend a lot more time finessing our laryngoscopy skills than the way we call our consults. Calling an efficient and effective consult / admit can greatly improve our on-shift flow, and therefore happiness. The rest of this post will focus on the art of how to call a consult. Read more →