March 24, 2014

Preoxygenation and apneic oxygenation are key in emergency airway management, prevention of desaturation, and very important to patient safety.  One of the best papers I have ever read on this was written by Scott D. Weingart (@emcrit) and Richard M. Levitan (@airwaycam) in the Annals of Emergency Medicine in March 2012. This article reviewed techniques in preoxygenation and peri-intubation oxygenation in adult patients requiring tracheal intubation. 

March 21, 2014

This year I was fortunate enough to attend the Social Media And Critical Care (SMACC) conference from Mar 19th - 21st, 2014 at the Gold Coast Australia, also known as SMACCGOLD.  SMACC is a modern, academic meeting, mixed with on-line technologies to deliver innovation in education in the fields of emergency medicine and critical care. This conference addresses important clinical issues in a format that is energetic, cutting edge, and yet reputable. So what did I learn?  Well, more than I can put into one post, but some of the highlights are listed below.

February 17, 2014

Critical illness is a life-threatening multisystem process that can result in significant morbidity and mortality. Timely, appropriate, and effective care for these patients is something all emergency physicians strive for. Using data from clinical trials of previous years, we can improve patient management and outcomes. In this post, I list my five critical care articles for your clinical practice in the care of these patients.

January 25, 2014

The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes.  Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with good patient outcomes.

November 1, 2013

Pauses in chest compressions are known to be detrimental to survival in cardiac arrest, so much so that the 2010 American Heart Association (AHA) emphasize high-quality compressions while minimizing interruptions. There have been some studies that now advocate for continuous chest compressions during a defibrillation shock. There have been substantial changes to external defibrillation technology  including:
  • Biphasic shocks with real-time impedance monitoring to reduce peak voltages
  • Paddles being replaced by adhesive pre-gelled electrodes
  • Enhancement in ECG filtering permitting rhythm monitoring during chest compressions.
So the mantra of "hard and fast" may be true when it comes to CPR, but the real question now becomes, should we be continuing CPR during defibrillation?