14 Jan 2021

January 14, 2021

Written by REBEL Crit, REBEL EM
Background Information: Out-of-hospital cardiac arrest (OHCA) remains a diagnostic challenge to providers and a significant burden on healthcare systems globally. Despite the advancement of invasive medical therapies such as percutaneous coronary intervention (PCI) and extracorporeal membranous oxygenation (ECMO) at designated cardiac catherization centers, the majority of these patients sustain poor outcomes due to hypoxic brain injury. Clinical features of neurologic injury are typically delayed until 72 hours after admission. As a result, many neuro-prognostication tools have been developed to assist with clinical decision making as well as reduce expensive futile interventions.1 Some of these neuroprognostication tools include the Cardiac Arrest Hospital Prognosis (CAHP), OHCA and Targeted Temperature Management (TTM) risk tools. Unfortunately, these are complex and time consuming, thus limiting their use in the emergency department (ED). The authors of the following study sought out to develop and validate a point-based risk score to support clinical decision making and predict neurologic outcomes using the cerebral performance category (CPC) scale (Figure 1)
Medical Categories: Cardiovascular, Neurology, Resuscitation
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31 Dec 2020

December 31, 2020

Written by REBEL Crit
Introduction: Respiratory failure is an uncommon but important complication in pregnancy and the postpartum period, occurring 1 in 500 pregnancies.1 Respiratory failure can result from pregnancy-related conditions, conditions exacerbated by pregnancy, or pathologies common to the general population (Table 1). Understanding of respiratory failure and mechanical ventilation in pregnant patients is limited by the relative rarity of the condition as well as the exclusion or underrepresentation of pregnant patients in the majority of the trials that have informed our understanding of respiratory failure. As such, respiratory failure in this vulnerable population is a stressful emergency that requires understanding of the anatomical and physiological changes of gestation as well as meticulous preparation for a difficult airway. 
Medical Categories: Obstetrics and Gynecology, Resuscitation
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21 Dec 2020

December 21, 2020

Written by REBEL Crit
Background:  Vasopressors are usually given through central venous catheters (CVC). This, however, is a time-consuming process and placement of a peripheral venous catheter (PIV) is much faster. Each hour of delay has been associated with a 2% increase in in-hospital mortality.2 Using PIV for the infusion of vasopressors can be an effective alternative for time-sensitive patient care in the emergency department (ED). Previous studies, however, have been inconclusive regarding complications of vasopressor infusion through PIV.
Medical Categories: Resuscitation
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14 Dec 2020

December 14, 2020

Written by REBEL Crit
Background: In the US out-of-hospital cardiac arrest (OHCA) has an estimated survival rate of <10% overall, but slightly better survival rates with shockable rhythms of approximately 30% [2]. A small proportion of these patients will have refractory VF/VT OHCA not treatable by standard ACLS guidelines.  One possible modality for these patients is extracorporeal membrane oxygenation (ECMO, followed by immediate coronary angiography and percutaneous coronary intervention (PCI).  How would this ECMO-facilitated resuscitation strategy fair when applied in a US metropolitan community?
Medical Categories: Resuscitation
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19 Nov 2020

November 19, 2020

Written by REBEL Cast, REBEL Crit
Background Information: Central venous catheterization is a common procedure performed in the ICU for the purposes of drug administration and resuscitation. The subclavian vein is the more preferred access site given its fixed puncture location, ease for nursing access and low incidence of infections.1 Landmark guided catheterization has a widely variable success rate and has been shown to increase the risk of complications such as hematoma formation and pneumothoraxes.2,3 The use of real-time ultrasound guidance has thus led to more central lines being placed in the internal jugular and femoral lines, however there is substantial debate regarding its use in subclavian vein catheterization.4,5 The authors of this study sought to compare the efficacy and safety of static ultrasound-guided puncture with traditional anatomic landmark guided subclavian vein puncture.
Medical Categories: Procedures and Skills, Resuscitation
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