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But I get a ton of clinical cases and questions by email or the contact form that have not been covered on a podcast yet. I love this–it exposes me to some great cases I would never hear about otherwise. Problem is, up until this point, it has been a 1 on 1 conversation. This is sort of a waste because nobody else benefits except you and me. So in the future, when you have a  case or question like this, I would love it if you posted to the Google Plus EMCrit Community page. This allows a few things:

  1. it allows my answer to be seen by a much larger group of people
  2. it allows folks smarter than me to chime in as well
  3. it keeps a record of these case interactions so I can refer people to them in the future

So how do you do it? Easiest way to learn is to watch this video:

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Comments

  1. Fionna Lowe says:

    First of all, thank you Scott for the great podcasts, which have managed to make my recent hour long commute time well spent!
    I am an Emergency Medicine Trainee in the UK, and as part of of my final exams need to write a in depth critical appraisal topic review (basically a literature review). My topic is ‘ In a patient in traumatic cardiac arrest following blunt trauma, in whom a eFAST scan idetifies a pericardial effusion, is there any benefit of performing an Emergency Department Thoracotomy?’.
    There is a lot of research out there, but none looking at blunt TCA with an identified potential cardiac tamponade, and whegher this small select group might have a better then nil outcome from EDT.
    I am hunting for any as yet unpublished research, or papers awaiting publication, or any evidence at all relating to this question that I might have missed in my literature searches.
    PLEASE HELP!! AND THANKS!

  2. Hi Scott,
    I really liked the chapter about errors in your book, but I can’t find any links on the blog to discussing these.
    Any external links/ resources on cognition etc would be great
    Will

  3. Kelly Irwin says:

    I have a question: I listened to the first and second vent lectures which I loved- but you talk about IFR and we don’t have that on our vent (LTV 1200). We have I -time which on an adult on our vent ranges from 0.3 to 3.0. I could find specific i-times for infants and pediatrics but not adults. Without having to do an equation what is the standard i time for an adult? Our vent has been at 1.0, which according to the pediatric information is less than recommended for over 6 years old (1.2). Thanks!

  4. Johnsa says:

    Hi Scott,

    My question relates to the Boston Bombings.
    Jeff Bauman lost both his legs in the attack but did not appear to lose a
    great quantity of blood.
    This is something I do not understand.
    Can you clear this up for me ?
    I have searched the internet but have been unable to find an answer.
    I understand that cauterisation and crushing injuries can restrict blood loss but
    I do not think these causes were relevant in this instance.

    Many Thanks

    John

    • aside from those mechanisms; hypotension will lead to limited blood loss until someone raises the pressure.

      • Johnsa says:

        Thank you for responding.

        I looked up hypotension and it did not mention trauma as a cause.

        Can you explain how it would be a factor in the case of Mr Bauman ?

        Many Thanks

        John

  5. Johnsa says:

    Sorry !

    Mr Bauman had 2 people lying beneath him soon after the explosion which removed his legs, his right leg above the knee , his left below the knee.
    I would have expected those 2 people to have had significant amounts of his blood on them. Subsequent photographs do appear to show this to be the case.

    I am sure there is a good medical reason for this and I would like to know what it is.

    From your last answer you seemed to imply that hypotension could be a factor given that the other reasons for limiting blood loss can probably be ruled out.

    This blog may not be the right place to get an answer to my question so please feel free to ignore this query as I am sure you have many more important things to attend to.

    Thanks for your responses

    Best wishes

    John

  6. Gordon Scriba says:

    Hello Scott,
    Question re: autotransfusion. “Literature at that time (I don’t have it at hand) strongly suggested that activated complement and clotting factors in shed blood from mediastinum / chest could initiate or worsen a consumptive coagulopathy. There was certainly no apparent benefit of this practice to patients and so it was discontinued. Reinfusion only occurs after washing.
    Subsequently, I have personally seen severe DIC associated with direct re-infusion of unwashed pericardial blood (high bleeding rate) following complications of ablation procedures.
    Re-infusing activated clotting factors, activated complement, etc. can obviously be harmful re: coagulopathy.” (hematologist). When PRBCs are available, should we be autotransfusing? We currently do not use autotransfusion due to availability of blood products and considerably lower frequency of traumas where autotransfusion may be utilized. Is there a podcast in the works to talk about autotransfusion? Pros and Cons? Benefits or harmful? Thanks!

  7. Hi Dr. Weingart,

    Thank you for the tremendous service you provide in medical education.

    I have a quick question. Several months ago I came across a link, I believe from your website, for an ED CME video lecture about evidence based treatment of decompensated CHF, about when/how to start Nitro, how to titrate Lasix (the diuretic threshold), the role of morphine etc. I believe it was an outside conference linked to EmCrit, and if this is the case, I would love to get the link. Thanks again,

    paul k pgy-1

  8. Caleb Morris says:

    I’m curious about your thoughts on paramedics in the ED. Do you utilize them where you practice? What roles do they play in the resuscitation team? Our local Lv1 trauma center utilizes them for inter-facility transfers, patient care in the ED, and on code teams. I’m eager to hear thoughts on the usefulness of medics as care providers. Thank you.

  9. Hi Scott-
    I’m writing from Bathurst (Australia) where I’m currently on rural rotation – the approach to sepsis is drastically different to what I’m used to.
    The anaesthetists here have a gadget (basically an ultrasound with built in calibration) that measures inotropy and CO, among other things. The idea is that poor inotropy is central to the pathophysiology of sepsis and we frequently ignore it until the patient is well down the resus pathway. They tell me that 4L fluid is too much for a failing heart to cope with, and 2L + early inotropes is the way to go. Apparently they can also detect patients with severe sepsis many hours before the lactate rises to > 4, i.e. before the patient is shocked at all, which is a huge plus for EGDT.
    The most impressive part – they say when their protocol is followed, mortality from severe sepsis was 6% (!!!!)
    But being a big fan and an EmCrit addict, I was suspicious I’d never heard you mention any of this. I really wanted to get your take on it. Have you heard of the USCOM? Do you buy it?

  10. Simon Martin says:

    Dr. Weingart,
    Many Emergency care providers of all disciplines suggest and teach that one can “feel” compliance when manually ventilating patients with a BVM, in fact in some of your podcasts including “The Crashing Asthmatic” you purport this as well. Might I suggest that while experience does help us in this regard, that this reported ability cannot be substantiated or validated. In “Peak pressures during manual ventilation” (Turk et al. Respir Care, 2005 Mar) it suggests that even experienced providers can deliver pressures of up to 100cmH2O which is clearly not safe. “The educated hand” (Spear et al. Anestesiology 1991) suggests the same in the pediatric patient population.
    I really like your suggestion of using the ventilator to “bag” patients and may well try that myself. I think we are fooling ourselves into thinking that BVM ventilation is goosd when all it is really is a ventilator that provides variable and unknown volumes and pressures that may harm our patients. We resort to manual ventilation when mechanical ventilation is failiing, but perhaps we should be getting better at using our ventilators to suit our patients. Is it not better to knowingly ventilate a patient with say pressures of 60cmH20 that just blindly bag and think we are doing good?
    I have this debate with colleagues over the years and would like you to weigh in.

    Respectfully,

    Simon Martin
    Advanced Care Flight Paramedic

  11. I have been appreciating your podcasts for the last few months and finally looked on your site today! I like the statement you make on your about me page which states “My career goal and the purpose of this blog and podcast is to bring Upstairs Care, Downstairs-–that is to bring ICU level care to the ED, so our patients can receive optimum treatment the moment they roll through the door.” I believe through listening to your lectures that you’re helping optimum care reach out to patients even before they “roll through the door” , I’d very much like to commend you for this, maybe your career goal statement could be amended to include this truth. Keep up the good work!
    Andrew Ball
    NREMT-P/Flight Paramedic

  12. Simon says:

    I had a question reagrding the MOPETT Trial. I did not see any mention regarding a time frame where it would be best to give the half dose tPA or a time frame where the benefits would not be as great. What is your personnal opinion on that)?

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