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.
Background: Upper endoscopy allows for the identification of the source of bleeding as well as hemostatic treatment for actively bleeding lesions In patients with upper gastrointestinal bleeding (UGIB). Definitive treatment with endoscopic hemostatic treatment can potentially stop bleeding in high-risk lesions and reduce further bleeding and the need for surgery. The optimal time for endoscopy to be performed is unknown. The definition of urgent varies depending on which study you read, ranging from 2 hours up to 12 hours. Additionally, most previous studies only enrolled patients who were not hemodynamically unstable or high-risk, which is frequently what we are dealing with in the emergency department.
The Glasgow-Blatchford score is a validated risk-assessment score for the prediction of clinical outcomes, including the need for intervention and risk of death. The score ranges from 0 to 23, with higher scores indicting a higher risk of further bleeding or death. A threshold score of ≥7 has been shown to be the most accurate predictor of whether a patient will need endoscopic treatment.2 There are conflicting results regarding urgent endoscopy (within 6 hours after admission) and mortality.
Salim, Jenny and I would like to announce the launch of a new REBEL EM project. Beginning in 2019, we'll be adding a core content section to the website. This will include core content blog posts and a core content podcast with a dedicated place on the parent site.
Instead of creating a separate podcast, we'll be bringing you REBEL Core Cast as part of REBEL Cast. This way, you won't need to download another podcast. Twice a month, Jenny and I will bring you a podcast based on a core topic in EM or based on pearls from our conferences.
See you all in the New Year!...Read More
In Episode 46a we discussed respiratory failure and NIV. In episode 46b we are going move on to the patient where you have tried NIV and your patient just doesn’t seem to be improving. You decide to intubate your patient and connect them to the ventilator. Now the ventilator starts beeping and your patient begins to decompensate. What are the steps you use to assess the problem and fix it?...Read More
Imagine you have a patient in respiratory failure sitting right in front of you. The patient has an increased work of breathing and obviously in distress. Monitors are beeping, nurses are asking you what you want to do, and if you don’t do something, the patient is going to arrest and potentially die. What is your framework for tackling these patients? Well, I had a chance to sit down with Haney Mallemat and discuss his framework for managing respiratory failure and NIV....Read More