Neutropenic Fever

20 Jul
July 20, 2018

Neutropenia: An absolute neutrophil count less than 500 cells/mm3 or less than 1000 cells/mm3 with a predicted decline to less than 500 cells/mm3

ANC = WBC x (neutrophil% + band%)

  • Mild: 1000 – 1500
  • Mod: 500 – 1000
  • Severe: 100 – 500
  • Profound: <100

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The Approach To The Most Common Cardiac Dysrhythmia: 8 Causes of Sinus Tachycardia

18 Jul
July 18, 2018

Have you ever heard an entire lecture on sinus tachycardia? Neither have I. It is the most common cardiac dysrhythmia seen in critically ill adults and kids, but it is the least frequently talked about. Sinus tachycardia may not be the sexiest rhythm and we don’t think of cardioverting it or giving some new anti-arrhythmic drug, but it is a sign that something may be seriously wrong. To be fair, it’s not the sinus tachycardia we are really worried about, but rather what’s causing the sinus tachycardia that should be our main concern. Read more →

Rebellion in EM 2018: STEMI Equivalents by Tarlan Hedayati, MD

16 Jul
July 16, 2018

The 1stannual Rebellion in EM Clinical Conference took place in San Antonio, TX on May 11th– 13th, 2018.  If you missed out in 2018, the Rebellion is coming back June 28th – 30th, 2019.  Stay up to date as we plan the conference for this upcoming year at www.rebellioninem.com.

The Missions of Rebellion in EM:

  1. Decrease Knowledge Translation: With 100s of journals and thousands of publications every year, it takes time for research to disseminate to clinical practice. Discussion of current literature and its application to practice is the key to facilitating safe best practices.
  2. Create a Community of Practice: It requires many to take care of the few. Patient care is a team sport that starts pre-hospital, continues through the ED, and finally into the hospital.
  3. Improve Patient Care: Decrease suffering and improve patient oriented outcomes

“Learning is always rebellion…every bit of new truth discovered is revolutionary to what was believed before.” -Margaret lee Runbeck- Read more →

How Do You FEEL About Echo in Cardiac Arrest?

13 Jul
July 13, 2018

Background: Focused use of ultrasound in resuscitation of patients with shock and cardiac arrest has become increasingly embraced in both the emergency department (ED) as well as in the prehospital setting. Application of ultrasound, particularly of echocardiography, has the potential to identify treatable causes of shock and arrest, identify shockable rhythms and identify the presence of mechanical activity. All of these can affect management decisions and, potentially effect outcomes. Recent studies have led to concerns that integration of point of care ultrasound (POCUS) in cardiac arrest increases pauses in compressions. Thus, it is important to establish what POCUS adds to shock and arrest management. Read more →

Pediatric DKA: Do Fluids Really Matter?

11 Jul
July 11, 2018

Background: The most feared complication in the clinical course of children with diabetic ketoacidosis (DKA) is the development of cerebral edema. Cerebral edema is rare (<1%) but is the leading cause of death in pediatric DKA. Many of the details about the risk factors as well as the mechanisms leading to DKA related cerebral edema are not well understood. Before we review the recent, groundbreaking study by Kupperman et al (1), examining the relationship between intravenous fluid content and rate of fluid administration in the development of DKA related cerebral edema, it’s important that we review the associated risk factors as well as the proposed mechanisms. It is important to know that the available data we are about to review comes from retrospective studies as well as case reports and case series and not from randomized control trials. Read more →

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