October 14, 2019

Shock is defined as circulatory failure leading to decreased organ perfusion.  In a shock state there is an inadequate delivery of oxygenated blood to tissues that results in end-organ dysfunction.  Effective resuscitation includes rapid identification and correction of inadequate circulation.  the finding of normal hemodynamic parameters (i.e. normal blood pressure) doe not exclude shock itself.  In this 17 minute and 26 second video, I will review the management shock - part 2b (Dobutamine, Milrinone, Vasopressin, Angiotensin II, & Selepressin).

October 10, 2019

Background: Serial lactate measurements is a common core measure that we follow in septic shock resuscitation. A number of readers have written in enquiring about whether resuscitation with lactated ringers instead of 0.9% saline would lead to increases in serum lactate.   It’s a great question, and one that I am not sure I had a solid answer for before reviewing this topic.  LR contains 28 mmol/L of sodium lactate and, on the surface, it seems reasonable to think that infusion of LR would lead to lactate increases. This could potentially confound the interpretation of serial serum lactate measurements.

October 9, 2019

Take Home Points 
  • Acute closed angle glaucoma is an ophthalmologic emergency that usually presents with sudden, painful, monocular vision loss.
  • Physical exam will reveal conjunctival redness, corneal haziness or cloudiness due to edema and a pupil that is mid sized and minimally reactive to light, a rock hard globe and IOP >/= 21.
  • These patients require emergent ophthalmology evaluation but treatment should be started empirically while waiting for the evaluation. Initial treatment to decrease IOP usually includes a topical BB such as timolol and topical AB such as apraclonidine and either IV or PO acetazolamide.  
 

October 7, 2019

Shock is defined as circulatory failure leading to decreased organ perfusion.  In a shock state there is an inadequate delivery of oxygenated blood to tissues that results in end-organ dysfunction.  Effective resuscitation includes rapid identification and correction of inadequate circulation.  the finding of normal hemodynamic parameters (i.e. normal blood pressure) doe not exclude shock itself.  In this 15 minute and 46 second video, I will review the management shock - part 2a (Norepinephrine, Epinephrine, Dopamine, Phenylephrine, and Push-Dose Pressors).

October 3, 2019

Life and work can serve up its fair share of adversity and setbacks that we have to contend with. In medicine we are often tasked to perform under time pressures to do complex procedures, deal with human suffering, and make decisions where life/death hang in the balance of our actions or inactions. Adversity has the power to create newfound strength, possibilities, and understanding if we can navigate through them effectively. Conversely, adversity can also destroy our passion, our self-confidence, and what is possible if we do not navigate through them effectively.  In this 20 minute talk from Rebellion in EM 2019, Jason Brooks talks about how adversity in and of itself does not lead to value, but it’s what we do with these adverse experiences that matter the most.