April 22, 2021

In the fall of 2014, while working overnight in the emergency department at a community hospital in NJ, a patient (let's call him John) presented with ACE inhibitor angioedema. At first glance, his lips were swollen, but his tongue and oropharynx were unremarkable, and there were no signs of respiratory distress. I ordered an "anaphylaxis cocktail" and checked on him a few moments later.  John's condition deteriorated. His tongue, now swollen, protruded and forced his mouth open. He spoke in a muffled voice and drooled his oral secretions. I quickly phoned anesthesia for fiberoptic intubation. My heart sank when I was notified they were unavailable.

April 19, 2021

Background: Tension Pneumothorax (TP) can occur as a potentially life-threatening complication of chest trauma. With the risk of respiratory and cardiac arrest, an immediate temporizing intervention for this condition is required by direct Needle Decompression (ND). In 2018, the Advanced Trauma Life Support (ATLS) recommendations changed from the 2nd intercostal space in the midclavicular line (ICS2-MCL) to the 4th/5th intercostal space just anterior to the anterior-axillary line (ICS4/5-AAL), whereas the European Trauma Course (ETC) trauma guidelines and the guidelines from the Royal College of Surgeons of Edinburgh (RCSEd) in the UK still adhere to placement in the ICS2-MCL for the preferred location of ND. Both chest wall thickness of the patient and needle length both play a role in the success rate of ND.  Although it is well known that Chest Wall Thickness (CWT) increases with BMI, it is unknown if the optimal place for ND may vary with BMI.

April 15, 2021

Background: In patients requiring mechanical ventilation, sedative medications are used for patient comfort and safety.  However, these medications can also lead to brain dysfunction (i.e. delirium or coma) and long-term cognitive impairment. Currently, the Society of Critical Are Medicine [2] recommends sedation with either dexmedetomidine or propofol targeted to light levels of sedation in adult patients receiving mechanical ventilation. The evidence for which agent to use thus far with respect to acute brain dysfunction or cognitive impairment after critical illness have been unclear in determining which agent should be used. In fact, the Society of Critical Care Medicine’s 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS Guidelines) recommends the use of either propofol or dexmedetomidine to target light sedation.