May 11, 2015

Sometimes the most profound academic concepts haven’t come from the wonderful medical conferences or hundreds of academic articles I’ve read, but they come from arenas completely tangential to the medical field.  The topic of this article is a great example of this phenomenon.  It came from of all places, a Southwest Airlines magazine.  It’s titled “In Criticism of Praise” by Heidi Stevens.  Being an optimist with four children and many medical students under my wing, (yes I view them as my children) I was initially offended by the title and it of course, it drew me in.

May 4, 2015

So I was recently invited to the Texas College of Emergency Physicians meeting in Austin, TX (April 23rd - 26th, 2015) and was asked to give a lecture on sepsis, titled "Optimizing ED Management of Sepsis." I was able to record my audio from that lecture and will summarize it on this blogpost and attach the audio to the lecture as well. Now usually on REBELCast I do a mini-critical appraisal of recent literature with Swami and Matt, but in this episode I am going to try and give you a succinct summary of the recent sepsis trials that have been released over the past 6 – 12 months.

April 30, 2015

There are approximately 8 to 10 million patients complaining of chest pain 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. Despite these numbers the American College of Cardiology/American Heart Association (ACC/AHA) recommends that low-risk chest pain patients receive serial cardiac markers followed by some sort of provocative/objective cardiac testing. Using this strategy amongst low-risk chest pain patients unnecessarily uses resources on those least likely to benefit. Low-risk chest pain patients have ACS rates of <2% and provocative/objective cardiac testing is associated with a significant amount of “downstream” testing (i.e. cardiac catheterization) due to false positive tests. To date, the HEART score has been examined in >6000 patients and demonstrated a high NPV for MACE at 6 weeks exceeding 98%, but until now there has been no randomized trial.

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.