In case you have not heard or not read it on the twittersphere, the American Heart Association just released their 2015 Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) in Circulation. I am joined by Mr. Security, Matt Astin for this episode and we both read through this massive 15 part document and came up with our top 5 updates and recommendations. Now this is just a list of our top 5 new or updated recommendations, that caught our attention, but certainly there are other recommendations. If you want the cliff notes version of the updates look through part I, titled the executive summary or the Highlights PDF which we will attach on the blog, but certainly as always we recommend reading the full document to form your own interpretations and opinions. Read more →
The countdown has begun:
#smaccDUB registration opens next week!
Background: Acetaminophen (paracetamol) is commonly used to lower the temperature of patients with fever suspected to be causeed by an infection in both homes across the world and the hospital. There are, however, opposing theories to the utility of decreasing fever in these situations. One side argues that fever places “additional physiological stress on patients,” who are already ill (Young 2015). Removing this source of increased metabolic demand would allow the body to allocate additional resources to fighting infection, respiratory function etc. On the other hand, fever may “enhance immune-cell function” and inhibit further growth and spread of an infecting pathogen (Young 2015). From a simple evolutionary standpoint, fever, which entails a significant cost likely evolved and persists because it benefits the host. To date we don’t have high-level evidence that acetaminophen treatment of fever due to probable infection is beneficial, ineffective, or harmful. Read more →
There has been a lot of debate over the recent years about the safety of crystalloid fluid therapy in acutely ill patients. Several observational studies have shown an increased risk of acute kidney injury (AKI) with the use of normal saline (NS). Other observational studies have shown a decreased risk of AKI when using a buffered solution (Hartmann’s solution, Plasma-Lyte (PL)). What is the best fluid to give to our patients who need fluid resuscitation? The answer to this question is not known, but another step in finding the answer was taken with the release of the SPLIT trial online by JAMA on October 7, 2015.
Background: Every year there are a handful of “game changing” publications that truly change how we care for our patients. One such paper was a paper by Scott Weingart and Richard Levitan in the Annals of Emergency Medicine in 2011 on the topics of preoxygenation and apneic oxygenation (This paper was already reviewed on REBEL EM – Preoxygenation and Apneic Oxygenation). As many of us know, one of the most common and feared complications dealt with in critically ill patients requiring endotracheal intubation is hypoxemia. Hypoxemia can subsequently lead to cardiac arrest and death. Since the advent of apneic oxygenation this common complication seems to have decreased in occurrence, but is apneic oxygenation effective in all settings? Read more →