Cough from respiratory illness is one of the most common reasons that patients seek care in both the outpatient primary care setting and the emergency department (ED). Cough due to respiratory illness is a self-limited condition in the majority of cases, but patients still seek care at clinics and EDs seeking relief or their symptoms. Maybe the reason for this is patients’ expectations of duration of cough and the actual natural history of cough from respiratory illness are mismatched. So how long does a cough from respiratory illness last? Read more →
Background: Respiratory tract infections and pneumonia are the 3rd leading cause of death worldwide. Although morbidity and mortality has improved slightly with the advent of antibiotics, there is still a significant long-term morbidity and mortality associated with this disorder. It is well known that in pneumonia, there is an excess release of circulating inflammatory cytokines which cause further pulmonary dysfunction. Maybe the use of systemic corticosteroids, which have anti-inflammatory effects, could help attenuate this systemic inflammatory process and thus improve outcomes. So is there any benefit to adjunct prednisone therapy in community acquired pneumonia?
Welcome to the February 2015 REBELCast, where Swami, Matt, and I are going to tackle two critical care topics that come up frequently in clinical practice in both the pre-hospital setting as well as the emergency department. Today we are going to specifically tackle:
Topic #1: Administration of Rapid Sequence Intubation (RSI) Medications via an Intraosseous line.
Topic #2: Compressions During Charging (CDC) in Out of Hospital Cardiac Arrest (OHCA)
In the United States, trauma is the leading cause of death among patients between the ages of 1 and 44 years of age and the third leading cause of death overall. Approximately 20 to 40% of trauma deaths occur after hospital admission and are a result of massive hemorrhage. There have been no large, multi-center, randomized clinical trials with survival as a primary end point that support optimal trauma resuscitation practices with approved blood products and therefore there are many conflicting recommendations. The Prosective Observational Multicenter Major Trauma Transfusion (PROMMT) Trial demonstrated that many clinicians were transfusing patients with blood products in a ratio of 1:1:1 or 1:1:2 and that early transfusion of plasma was associated with improved 6-hour survival after admission.
The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial was designed to address the effectiveness and safety of 1:1:1 transfusion ratio vs 1:1:2 in patients with trauma who were predicted to receive a massive transfusion.
Background: Hyperkalemia is the most common electrolyte disorder seen in the Emergency Department and treatment of hyperkalemia is core knowledge of EM training for interns and focuses on:
1) Stabilization of cardiac myocytes with calcium salts2) Temporary shifting of potassium into cells (insulin, beta agonists, normal saline,magnesium, sodium bicarbonate)3) Removal of potassium from the body (i.e. loop diuretics, cathartics)4) Definitive Treatment (i.e. Hemodyalisis)
Although there is still some debate on the first two areas (i.e. is there truly a role for sodium bicarbonate?) our focus will be on the removal part of the algorithm, specifically, is there a role for kayexalate?