LOMAGHI Trial: Magnesium Sulfate for Rapid Atrial Fibrillation?

04 Oct
October 4, 2018

Background: Currently, several medications are recommended for the management of atrial fibrillation with rapid ventricular response in the emergency department including calcium channel blockers, beta blockers and digoxin (the optimal choice is still up for debate). Magnesium sulfate may play a role as a supplemental medication based on its ability to decrease the frequency of sinus node depolarization, prolongation of the refractory period of the atrioventricular node, and acting as a calcium antagonist inhibiting calcium currents in cardiomyocytes.  In addition,panerai radiomir replica intravenous magnesium is safe and cheap.  Most previous trials on the use of magnesium sulfate have rather small sample sizes or were performed in post-cardiac surgery patients.  Also, the exact dose of magnesium used in previous studies varied significantly making it difficult to determine which dose would be the most optimal in these patients.  Recently, the LOMAGHI study was just published trying to answer the questions behind many of these issues. Read more →

Building the “Perfect” Curriculum

02 Oct
October 2, 2018

I was asked to give a talk at ACEP 2018 on Building the Perfect Curriculum and given 25 minutes to make this happen.  As you can imagine there is no way the entirety of building a perfect curriculum can be done in 25 minutes nor is there such a thing as the perfect curriculum, as we are always evaluating and modifying our current curriculum. Therefore the perfect curriculum can always get better.  For the sake of this talk however, there are essentially 3 steps to building the perfect curriculum: A needs assessment, optimizing the learning, and evaluation of the curriculum.  I opted to focus on optimizing learning.  Every year it seems this talk focuses on Kerns 6 step approach to curriculum development, (which is simply one of many models out there) but there is no emphasis on what to do during lectures and weekly conferences. Read more →

Can’t We All Just Get Along? A Generational Survival Guide

02 Oct
October 2, 2018

Background: For the 1st time we have 4 generations in the workplace.  The reasons for this include, people are living longer on one end of the scale and there has been a huge acceleration in speed of information leading to quicker development of younger generations.  The remainder of this post will serve to describe a generational survival guide by explaining the reasons why each generation has the qualities that summarize why each generation is the way it is. Read more →

The CASA Exam: A Follow Up Study

01 Oct
October 1, 2018

Background: POCUS has become a powerful tool in the evaluation of critically ill patients in the ED.  However, in patients with cardiac arrest, the use of POCUS has been shown to significantly increase the duration of pauses.  This is concerning as high quality CPR with minimal interruptions is one of the keys to maximizing ROSC and survival with good neurologic outcomes. Recently, I had the chance to interview the lead author of the Cardiac Arrest Sonographic Assessment (CASA Exam) on REBEL Cast Ep 57 and on that episode we discussed a follow up study, which has finally been published in Resuscitation 2018. Read more →

REBEL Cast Ep 59: AIRWAYS-2 – Supraglottic vs Tracheal Intubation in OHCA

27 Sep
September 27, 2018

Background:There is a lack of high quality RCTs  investigating optimal airway management in patients with out-of-hospital cardiac arrest (OHCA).  The majority of evidence comes from observational studies and expert opinion. The observational trials have consistently favored basic airway management (i.e. BVM) over tracheal intubation [3]. Supraglottic airway(SGA) devices offer an alternative advanced airway management technique to endotracheal intubation (ETI) during OHCA. SGA devices may offer an advantage over ETI as they are simpler and faster to placeAdditionally, proficiency  with SGAs requires less training and ongoing practice. Although there have been several recent studies published on airway management in OHCA, this post/podcast will focus on the recently published AIRWAYS-2 trial. Read more →