21 Apr 2014

April 21, 2014

Written by REBEL EM
Patients with corneal abrasions typically come to the emergency department for eye pain.  Most physicians treat these with topical antibiotics, oral analgesia, and for those who are lucky enough 48 - 72 hour follow up with ophthalmology. Oral analgesia does a poor job of controlling these patients pain. Tetracaine is an esterase type anesthetic with a onset of action of 10 - 20 seconds and a duration of action of 10 - 15 minutes.  Use of topical anesthetics are very effective at reducing pain, but there use is discouraged secondary to poor wound healing of the corneal epithelium.  So what is the evidence for topical anesthetic use on corneal abrasions?
Medical Categories: Head, Eye, Ear, Nose, and Throat
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17 Apr 2014

April 17, 2014

Written by REBEL EM
Hyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. It is important to remember that the electrophysiologic effects of hyperkalemia are directly proportional to both the absolute plasma potassium and its rate of rise. However, neither the ECG nor the plasma potassium alone are an adequate index of the severity of hyperkalemia, and therefore providers should have a low threshold to initiate therapy. Classic teaching of the chronological ECG changes of hyperkalemia include:
  1. Peaked T waves
  2. Prolongation of PR interval
  3. Widening QRS Complex
  4. Loss of P wave
  5. "Sine Wave"
  6. Asystole
Medical Categories: Cardiovascular, Endocrine, Metabolic, Fluid, and Electrolytes
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4 Apr 2014

April 4, 2014

Written by REBEL EM
As many know Free Open Access Med(ical Ed)ucation (FOAM) is a concept that was developed in June 2012 at a pub in Ireland. Since its creation FOAM has developed into a collection of constantly evolving, collaborative, and interactive resources and tools with one main objective...to make the world a better place. At the heart of FOAM is the philosophy that high-quality medical education should be free and accessible to all who care for patients and to those who teach the art and science of medicine. Recently, I watched a video from the 2013 Social Media And Critical Care (SMACC) Conference given by Joe Lex that made me realize although the acronym only came into being recently, maybe the concept had historical origins (From Hippocrates to Osler to FOAM).
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24 Mar 2014

March 24, 2014

Written by REBEL Crit
Preoxygenation and apneic oxygenation are key in emergency airway management, prevention of desaturation, and very important to patient safety.  One of the best papers I have ever read on this was written by Scott D. Weingart (@emcrit) and Richard M. Levitan (@airwaycam) in the Annals of Emergency Medicine in March 2012. This article reviewed techniques in preoxygenation and peri-intubation oxygenation in adult patients requiring tracheal intubation. 
Medical Categories: Resuscitation, Thoracic and Respiratory
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21 Mar 2014

March 21, 2014

Written by REBEL Crit, REBEL EM
This year I was fortunate enough to attend the Social Media And Critical Care (SMACC) conference from Mar 19th - 21st, 2014 at the Gold Coast Australia, also known as SMACCGOLD.  SMACC is a modern, academic meeting, mixed with on-line technologies to deliver innovation in education in the fields of emergency medicine and critical care. This conference addresses important clinical issues in a format that is energetic, cutting edge, and yet reputable. So what did I learn?  Well, more than I can put into one post, but some of the highlights are listed below.
Medical Categories: Resuscitation, Trauma
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