22 Sep 2018

September 22, 2018

Written by REBEL EM
This past week, one hundred clinicians went back to work inspired. They were reinvigorated, motivated and full of knowledge.  They were the delegates, faculty and volunteers of #resusTO. This inaugural event (hopefully) laid the groundwork for many more to come as it was a success by any measure. ResusTO, the brain child of human factors guru and EM doc Chris Hicks, who along with the organizing committee of Andrew Petrosoniak, Jesse Spurr and Kari White, and a plethora of volunteers, orchestrated a human performance, education and simulation extravaganza! The conference held in Toronto, Canada sept 13th– 14th, 2018, was a special conference for so many reasons and you could feel it the moment you stepped up to the registration desk and received your name tag that noted, “Awesome human delegate.”
Medical Categories: Resuscitation
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13 Sep 2018

September 13, 2018

Written by REBEL EM

Warning: Limited Published Evidence on this Topic

You have just intubated a 4 year old with sepsis from a bad pneumonia. Post intubation BP is 70 systolic, while waiting for the epinephrine (adrenaline) infusion to come up from pharmacy you watch the BP decline into the 60 systolic range and start to use fluids to resuscitate. You are an accomplished adult resuscitationist, and are comfortable mixing, and pushing push dose epi in your adult patients. The following questions arise as you consider mixing a batch of push dose epi:
  • How much push dose epinephrine should you give this septic 4 year old?
  • Do pediatric patients need more or less epi when given in push dose format?
  • How do some pediatric intensivists and pediatric emergency physicians manage this problem?
Medical Categories: Pediatrics, Resuscitation
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10 Sep 2018

September 10, 2018

Written by REBEL EM
During a busy resuscitation it behooves the ED resuscitationist to avoid ordering therapies that have no clear benefit to their patients. Our nurses are overburdened, and adding interventions ‘just to be safe’ or ‘because we always do it’ is a great way to overwhelm our nursing colleagues. Bicarb administration is a contentious issue and many clinicians consider its use to fall firmly into the no-benefit camp, even when used in the management of severe metabolic acidosis. There have been no studies to date evaluating clinical outcomes  with the use of  sodium bicarbonate infusion therapy for severe metabolic acidemia, until now.  This post is a review of the recently published BICAR-ICU trial
Medical Categories: Resuscitation
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6 Aug 2018

August 6, 2018

Written by REBEL Cast
Background: POCUS has been touted as the stethoscope 2.0, a true game changer in patient care.  There is no patient population that this statement should hold more true for, than in patients with undifferentiated shock (SBP <100mmHg or SI > 1). Everyone has a story about how ultrasound changed their management or even saved a patient’s life. Unfortunately, the plural of anecdote is not data.  To date, there have not been any prospective randomized controlled trials examining POCUS outcomes on survival in this population.  Enter the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) trial.
Medical Categories: Resuscitation
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25 Jul 2018

July 25, 2018

Written by REBEL Cast
Background: In the ED, POCUS has become one of the most important tools in discovering both the diagnosis and in the management of critically ill patients.  cardiac arrest, is ultimately as sick as a person can get in the spectrum of critical illness.  I mean how can someone be deader than dead, right?  There has been a slew of literature evaluating the use of POCUS in cardiac arrest and many providers have started to incorporate its use into their practice.  Newer literature, however indicates that the use of POCUS prolongs CPR pauses which ultimately impacts good neurological survival.  POCUS protocols may help decrease cognitive load, but many are too cumbersome and complicated.  Enter the Cardiac Arrest Sonographic Assessment (CASA) exam.
Medical Categories: Resuscitation
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