1 Nov 2013

November 1, 2013

Written by REBEL Crit
Pauses in chest compressions are known to be detrimental to survival in cardiac arrest, so much so that the 2010 American Heart Association (AHA) emphasize high-quality compressions while minimizing interruptions. There have been some studies that now advocate for continuous chest compressions during a defibrillation shock. There have been substantial changes to external defibrillation technology  including:
  • Biphasic shocks with real-time impedance monitoring to reduce peak voltages
  • Paddles being replaced by adhesive pre-gelled electrodes
  • Enhancement in ECG filtering permitting rhythm monitoring during chest compressions.
So the mantra of "hard and fast" may be true when it comes to CPR, but the real question now becomes, should we be continuing CPR during defibrillation?
Medical Categories: Resuscitation
0 Likes
1 Nov 2013

November 1, 2013

Written by REBEL EM
Recently, I have been asked by several students at my home institution (UTHSC at San Antonio) to help them understand bundle branch blocks.  This is different than some of my usual posts because it is meant to be more educational than evidence based.  So here we go.  The normal conduction system of the healthy heart is shown to the right.  If there is a delay or block in the left or right bundle, depolarization will take longer to occur. Therefore we get a widened QRS (>0.12 sec or >3 small boxes).
Medical Categories: Cardiovascular
26 Likes
1 Nov 2013

November 1, 2013

Written by REBEL EM
ECG interpretation is one of the most important skills to master as an emergency  physician, and its interpretation can be very complex and frustrating. ECG manifestations can be very subtle, and sometimes the earliest and only ECG change seen will be reciprocal changes alone. To further complicate this, many patients have the atypical symptoms of nausea/vomiting, weakness, or shortness of breath and not chest pain.
Medical Categories: Cardiovascular
1 Like
1 Nov 2013

November 1, 2013

Written by REBEL EM
In Advanced Trauma Life Support (ATLS), we learned that a carotid, femoral, and radial pulse correlates to a certain systolic blood pressure (SBP) in hypotensive trauma patients.  Specifically ATLS stated:
  •  Carotid pulse only = SBP 60 – 70 mmHg
  •  Carotid & Femoral pulse only = SBP 70 – 80 mmHg
  •  Radial pulse present = SBP >80 mmHg
Medical Categories: Trauma
1 Like
1 Nov 2013

November 1, 2013

Written by REBEL EM
Nasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence support the logic? Most studies state that endoscopy should occur within 24 hours of presentation, but the optimal timing within the first 24 hours is unclear.  Rebleeding is the greatest predictor of mortality, and these patients benefit from aggressive, early endoscopic hemostatic therapy and/or surgery. So what are the arguments for and against NGL?
Medical Categories: Abdominal and Gastroinstestinal
2 Likes
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