6 Aug 2015

August 6, 2015

Written by REBEL EM

Back in August 2014, we posted an in depth review on medical expulsion therapy (MET) with tamsulosin in patients with renal colic. The summary of that post was:

“Clearly, there is disagreement in the literature. None of the studies are ideal. We continue to lack a large, RDCT done on patients presenting to the Emergency Department with renal colic.

The best evidence we have DOES NOT show a significant benefit to the use of tamsulosin in renal colic.”

Since that post, two well done RDCTs were published so we thought a brief review of each of these articles and updated recommendations were warranted.

Medical Categories: Renal and Genitourinary
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3 Aug 2015

August 3, 2015

Written by REBEL Cast
Background: We know that cardiac arrest is a devastating disease and that it occurs in approximately 400,000 Americans each year. In the few patients who achieve return of spontaneous circulation (ROSC) and survive past the pre-hospital stage, mortality rates range from 50 – 60% depending on which sources you read. Neurologic injury is the primary reason for mortality in cardiac arrest patients who do survive to hospital admission and while therapeutic hypothermia (TH) is now an established and recommended therapy to help improve survival and neurologic outcomes in cardiac arrest survivors, the mortality rate is still high in this population.   Acute coronary syndrome (ACS) accounts for the majority of cases of cardiac arrest in adults and some recent studies have shown that early cardiac catheterization (CC) and immediate percutaneous coronary intervention (PCI) are associated with improved survival following cardiac arrest. However, many of the patients included in these studies had ST-elevation myocardial infarction (STEMI). There is already a Class 1 recommendation for early CC & PCI in the setting of STEMI following cardiac arrest, but the data on early CC in comatose post-arrest patients without STEMI is very limited. Post-resuscitation electrocardiogram (ECG) is often unreliable and lack of ST-elevation has a poor sensitivity for the diagnosis of acute coronary occlusion. Recently the American College of Cardiology/American Heart Association (ACC/AHA) proposed and published a new consensus statement an algorithm to stratify cardiac arrest patients who are comatose for CC activation. As part of this algorithm non-ST elevation myocardial infarction (NSTEMI) was added as an indication for CC activation. So with that introduction today on REBEL Cast we are going to specifically tackle:
  • Topic: Early Cardiac Catheterization in OHCA Survivors with Non-STEMI
Medical Categories: Cardiovascular, Resuscitation
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30 Jul 2015

July 30, 2015

Written by REBEL Crit

As the world of Free Open Access Medical Education has expanded over the last 5 years, one area that has been a laggard is the traditional journal. Although some journals release a limited number of articles in an open access format (NEJM, Annals of EM, Academic EM, EM Australasia, etc.) we haven’t seen a true open-access journal that is free to publish and free to read. This changed on June 24th, 2015 when the first issue of Critical Care Horizons was released.

Medical Categories: Resuscitation
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27 Jul 2015

July 27, 2015

Written by REBEL EM
FEVER shows up beside the name of a new 3 year old that has just been checked into your department. This can be accompanied by many feelings when you see it from “Why are they here ?” to “I hope the child is not dying.” This is a reasonable range of thoughts depending on your level of experience and resources. Many variables are important with this “chief complaint” from how the temperature was actually obtained, to immunization status of the child, to how does the child look, and many more. In my estimation, fever gets a bad rap from general society. It’s our job to set the tone and fight “fever-phobia” when needed. Let’s examine some aspects of pediatric fever to change your mindset from apprehension, to “I’ve got this”.
Medical Categories: Pediatrics
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23 Jul 2015

July 23, 2015

Written by REBEL Crit
Advanced Cardiac Life Support (ACLS) provides a well structured framework for those who resuscitate infrequently. There is room to move beyond the algorithm to potentially provide better care for our patients for those who resuscitate frequently. I will describe some tweaks to the way CPR, defibrillation, and medications are delivered in the arrests I manage.
Medical Categories: Resuscitation
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