April 27, 2015

We’ve had some heated debates on the topic of hands-on defibrillation (HOD) for the past few years. We all know the most important time to avoid a pause during CPR is the perishock pause ([1]). We also know that despite lots of safety data ([2], [3]) and safe experience doing HOD ([4]) there are still concerns over the potential electrical leak using common exam gloves ([5], [6], [7], [8], [9]). For those who don’t enjoy a little electrical spice in your resuscitations, some recent articles have shown ways in which the safety of HOD can be mitigated using inexpensive tools.

April 23, 2015

When selecting a local anesthetic agent for skin wounds I have historically been taught to use lidocaine to provide a faster onset, and to use bupivacaine for a longer duration of action. It can be time consuming to find 0.5% Bupivacaine with epinephrine and 2% Lidocaine with Epinephrine to produce a final mixture of 1% Lidocaine and 0.25% Bupivacaine with Epinephrine.
  • If there is no difference in effect between these agents time could be saved when drawing up local anesthetics.

April 20, 2015

Welcome back to a special edition, or should I say "skeptical edition" of REBELCast. We have started to do something new by inviting guests onto the show to discuss papers in the literature they find interesting.  This month I had the pleasure of working with Ken Milne, an emergency room physician in Canada. Today, Ken and I are going to specifically discuss a new device that recently got FDA approval for CPR in Out of Hospital Cardiac Arrest (OHCA), and the question we are trying to answer is: Is active Compression Decompression CPR with Augmentation of Negative Intrathoracic Pressure for Treatment of Out-of-Hospital Cardiac Arrest superior to standard CPR?

April 16, 2015

There are approximately 8 to 10 million patients coming to Emergency Departments (EDs) in the United States annually. In the US, we use a very liberal testing strategy in order to avoid acute coronary syndrome (ACS) in patients presenting with chest pain. This results in over 50% of ED patients with acute chest pain receiving serial cardiac biomarkers, stress testing, and cardiac angiography at an estimated cost of $10 to $13 billion annually and yet fewer than 10% of these patients are diagnosed with ACS. The 2-hour accelerated diagnostic protocol (ADAPT) combines  0 and 2 hour cardiac troponin (cTn), electrocardiograms (ECGs), and an adapted Thrombolysis in Myocardial Infarction (TIMI) score to help identify ED patients safe for early discharge. Previous studies show that this strategy can identify as many as 20% of patients for early discharge with a high sensitivity of 97.9% to 99.7% for major adverse cardiac events (MACE) at 30 days. This ADP has yet to be tested in a US population until now.

April 13, 2015

This post is part 2 of epistaxis dogma. In the first post, we discussed the (dis)utility of prophylactic antibiotics in patients with epistaxis who require nasal packing. Here, we will take on dogma #2: Dogma #2: Patients with posterior packs for epistaxis should be admitted to the ICU for continuous monitoring due to the risk of life-threatening bradydysrhythmias. Unfortunately, the literature here is even sparser than with prophylactic antibiotics. An extensive literature search (paging research librarian) turned up two articles that were repeatedly cited.