March 16, 2020

Traditionally, endotracheal intubation has been the gold standard for airway management in cardiac arrest. However, more recent data suggests that maybe less is more (i.e. supraglottic airways and/or bag valve mask ventilation).  The AHA guidelines have also de-emphasized airway management as the old acronym of ABC's has now been changed to CAB's.  In this talk from Rebellion in EM 2019, Dr. Chris Hicks, MD discusses the optimal airway management in OHCA.

March 5, 2020

Welcome back to REBEL Cast, I am your host Salim Rezaie.  In this episode we are going to review a recent focused 2019 update to the American Heart Association (AHA) pediatric advanced life support (PALS) guidelines from 2018-19. This 2019 PALS Update addresses 3 concerns:
  1. Pediatric advanced airway management in pediatric cardiac arrest
  2. Extracorporeal cardiopulmonary resus (ECPR/ECMO) in pediatric cardiac arrest
  3. Pediatric targeted temperature management (TTM) during post-arrest care

February 27, 2020

A 57-year-old man is watching his son’s baseball game when he suddenly collapses. Witnesses did not appreciate a pulse, so they started CPR. Unfortunately, an AED was not available. EMS was called and when they arrived within minutes the patient was found to be in vfib arrest and was defibrillated. When the patient arrived to the hospital, he was in PEA arrest. Ultrasound of the patient’s heart showed some coordinated cardiac activity. ACLS doesn’t really tell us how to proceed with cardiac activity but not enough to generate a pulse on the monitor.

February 26, 2020

Take Home Points 
  • No palpable pulse does not equal no perfusion. We aren't great at feeling pulses
  • Patients with moderate to severe signs and symptoms of lithium toxicity should be considered for hemodialysis
  • Always consider serious causes of back pain before simply treating with analgesics
  • Consider trauma as well as other toxic exposures (I.e. CO and CN) in patients with major burns

February 17, 2020

Background: In REBEL Cast Episode 73, Anand Swaminathan and I discussed two recent studies on the safety of peripheral vasopressors from two large trials [1][2]. An email from good friend Rory Spiegel brought my attention to yet another trial on this topic [3]. I think we can all agree that in patients with septic shock, or shock in general, the administration of vasopressor agents early, can help to stabilize patients and reverse end-organ hypoperfusion.  Traditionally, this has been done through central venous catheters (CVCs) due to the hypothetical risk of extravasation injury to extremities.  The flip side of this is, that central venous catheters are not without their own risks and time to place them can delay a therapy that may benefit patients.
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