For those who haven't checked out the site already R.E.B.E.L. EM stands for Rational Evidence Based Evaluation of Literature in Emergency Medicine. (Edit: name changed 2/2016) The blog was launched in October 2013, and continues to grow every month, and with that growth we are excited to announce the introduction of REBEL Cast. ...Read More
Typically, the initial evaluation of blunt trauma patients involves a supine anteroposterior (AP) chest x-ray (CXR) which has a poor sensitivity for the detection of pneumothorax (PTX), and has been reported as low as 20% - 48%. Following the CXR computed tomography (CT) has been the standard for the diagnosis of pneumothorax. The use of ultrasonography to diagnose pneumothorax was first described in 1986 in animal studies. Since then there have been many studies that have shown bedside ultrasound can rapidly detect pneumothorax, helping avoid serious potential consequences (i.e. tension pneumothorax), especially in patients requiring mechanical ventilation. There are several different sonographic signs that can be used to detect pneumothorax, specifically, sonographic lung sliding. But how good is ultrasound for the detection of pneumothorax?
Please welcome a new development in critical care publishing with the launch of a new open access critical care journal: CRITICAL CARE HORIZONS!!! This will be a fresh, new, original voice in the critical care literature, offering thought provoking, cutting-edge commentary, opinion papers, plus state-of-the art review articles....Read More
89 year old male with PMH of hypertension, stage 3 chronic kidney disease with chief complaint of shortness of breath. Several days ago patient had a laminectomy for radicular pain. He was doing fine post-operatively and began to develop gradual shortness of breath. He had no complaints of chest pain, nausea/vomiting, fevers, diaphoresis, but did have some weakness. There were no prior ECGs for comparison.
BP: 98/48 HR: 103 RR: 18 O2 on RA: 94% Temp: 38.6
JVD to the angle of the mandible
Bilateral lower extremity pitting edema
Labs: Na 125, K+ 4.2, Creatinine 2, BNP > 2500
ECG from triage is shown......Read More