November 21, 2019

Background: The IOTA trial, was a systematic review and meta-analysis of 25 RCTs enrolling 16,000 patients with sepsis, critical illness, stroke, trauma, MI, cardiac arrest, and/or emergency surgery. In this review it was found that liberal use of O2 resulted in a higher in-hospital and 30d mortality with NNH of 143 and 125 respectively compared to conservative O2 therapy.  Since supplemental oxygen is commonly used in the critically ill, it is important to establish parameters for oxygen supplementation, especially in patients undergoing mechanical ventilation where there is no good data regarding strategies for oxygen administration.

November 14, 2019

Background: Septic shock is the most severe form of sepsis. It is characterized by vasodilation and increased capillary permeability leading to hypotension and tissue hypoxia.  The initial treatment of septic shock includes early identification, intravenous fluids when necessary, appropriate broad-spectrum antibiotics, source control and organ support. Vasopressor therapy is often required to maintain adequate perfusion to support end organs.  Norepinephrine is the accepted first-line vasopressor for patients in septic shock, but it is not always effective in patients with extreme vasoplegia due to sepsis. Selepressin, a selective vasopressin V1a receptor agonist, is a non-catecholaminergic vasopressor that may assist in these patients.  It works by mitigating vasodilatation, vascular leakage, and tissue edema, but without V1b- or V2-mediated effects seen with vasopressin, which result in increased procoagulant factors, salt/water retention, nitric oxide release, and corticosteroid stimulation.

November 5, 2019

APPLY NOW: REBEL EM’s 2020 Infographic Competition for Essentials of Emergency Medicine Education Fellowship Program The Essentials of Emergency Medicine (EEM) conference is in May 2020, but the opportunities to attend start NOW. This conference is one of the largest live EM educational conferences in the world with over 2,000 attendees. The conference organizers, led by Dr. Paul Jhun, are again offering an amazing opportunity for EM residents anywhere in the world to serve as an EEM Fellow for the next EEM conference May 21 - 23, 2020.

November 4, 2019

Background: Despite decades of experience with endotracheal intubation, we continue to find approaches to improving the process of how we intubate. In this talk at Rebellion in EM 2019, Rob J. Bryant, MD gave a 14 minute 12 second talk on 3 things that have changed the way he intubates (Back Up Head Elevated - BUHE, Bougie 1st Intubation, & Team Management).  

October 30, 2019

Background: Currently, alteplase is the mainstay of treatment of acute ischemic stroke.  Advocates of alteplase suggest that the benefit of alteplase is greatest when given early and declines with increasing time from stroke symptom onset (i.e. time is brain).  Therefore, the AHA/ASA guidelines recommend intravenous alteplase within 4.5 hours after stroke onset, which is based on very weak evidence (i.e. NINDS & ECASS III). Due to weak evidence in support of it’s use and significant patient risks associated with alteplase, it’s use in acute ischemic stroke remains controversial.  One of the big issues is that by decreasing the time for evaluation and treatment, there is an increased risk of administrating alteplase to patients presenting with noncerebrovascular conditions that can resemble an acute ischemic stroke (i.e. stroke mimics).  This puts patients with no chance of improvement with alteplase at risk for increased mortality and symptomatic ICH.  There is some limited data on the safety of alteplase in stroke mimics and this study adds to that knowledge.
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