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REBEL Cast Episode 21: Sensitivity of Early Brain CT to Exclude Aneurysmal Subarachnoid Hemorrhage

Background: Headache accounts for approximately 2% of all ED visits. One of the most serious etiologies of headache is aneurysmal subarachnoid hemorrhage (SAH), which accounts for 4 – 12% of ED patients with thunderclap headache. There have been several studies ...

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Neurology

Should we be Using Apneic Oxygenation (ApOx) in the ED?

Background: Tracheal intubation is a procedure that is often performed in the ED on patients in critical condition. Because of this, there is the potential for complications such as hypoxemia, hypotension, dysrhythmias, aspiration, and cardiac arrest. Apneic Oxygenation (ApOx) is ...

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Resuscitation

Five ECG Patterns You Must Know

Background: The electrocardiogram (ECG) is one of the most useful diagnostic studies for identification of acute coronary syndrome (ACS) and acute myocardial infarction (AMI). The classic teaching is ST-segment elevation myocardial infarction (STEMI) is defined as symptoms consistent with acute ...

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Cardiovascular

Xanthochromia Detection: Visual Inspection vs. Spectrophotometry

Background: Although non-contrast head CT (NCHCT) has near perfect sensitivity (98-100%) in detecting aneurysmal subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset, sensitivity declines after 6 hours. As a result of declining sensitivity, lumbar puncture (LP) continues ...

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Neurology

Cardiocerebral Resuscitation: Hands-Only CPR

One of the major reasons contributing to dismal survival rates in out-of-hospital cardiac arrest (OHCA) is the lack of bystander initiated cardiopulmonary resuscitation (CPR). Even though the majority of OHCA is witnessed, only 1 in 5 patients will receive bystander ...

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Resuscitation

Clinical Decision Instruments in Minor Head Trauma – New Orleans + Canadian Decision Instruments

Background: CT scans are frequently done after minor head injury to evaluate for intracranial hemorrhage. While CT scans are an excellent tool for diagnosing or ruling out this disorder, they are not without harms including radiation exposure, cost and department ...

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Trauma

Classic Journal Review: The OPALS Study

  The Ontario Prehospital Advanced Life Support (OPALS) Study Background: Sudden cardiac arrest is common and, obviously, very bad. In the US, there are about 500,000 cardiac arrests each year. About half of these cardiac arrests are OHCA and the ...

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Resuscitation

Modified Sgarbossa Criteria: Part Deux

Background: Left Bundle Branch Block (LBBB) on the ECG makes accurate recognition of ST-Elevation Myocardial Infarction (STEMI) rather difficult. The 1996 and 2004 American College of Cardiology/American Heart Association (ACC/AHA) STEMI guidelines recommended immediate reperfusion therapy for patients with potentially ...

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Cardiovascular

Does a Normal Head CT Within 6 Hours of Onset of Headache Rule Out SAH?

Background: The traditional standard workup for ruling out subarachnoid hemorrhage (SAH) has been a non-contrast head CT and, if negative, a lumbar puncture. The thought behind this is that the sensitivity of head CT to rule out SAH is not ...

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Neurology

The Role of TEE in Cardiac Arrest

Background: Sudden cardiac arrest has very poor outcomes; less than 11% of patients in cardiac arrest in the Emergency Department survive to discharge from the hospital. The management of cardiac arrest is algorithmic because providers have limited tools at their ...

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CardiovascularResuscitation
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