EMCrit Project https://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Mon, 10 Dec 2018 19:24:52 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.8 http://emcrit.org/feed/podcast/ Help me fill in the blanks of the practice of ED Critical Care. In this podcast, we discuss all things related to the crashing, critically ill patient in the Emergency Department. Find the show notes at emcrit.org. Scott D. Weingart, MD clean episodic Scott D. Weingart, MD spambin55@gmail.com spambin55@gmail.com (Scott D. Weingart, MD) 2009- Online Medical Education on Emergency Department (ED) Critical Care, Trauma, & Resuscitation EMCrit Project http://emcrit.org/wp-content/uploads/powerpress/3000x3000-emcrit.jpg https://emcrit.org Tox and Hound – Enter Clonidine https://emcrit.org/toxhound/enterclonidine/ https://emcrit.org/toxhound/enterclonidine/#respond Mon, 10 Dec 2018 19:24:52 +0000 https://emcrit.org/?p=455929 by Sarah Shafer As promised in my last post, where I discussed the utility of naloxone in clonidine overdose, we’re going to spend some time today talking about clonidine in opioid withdrawal. Is it a useful therapy for treating opioid withdrawal, or like Claudius in Hamlet, a gaslighting distractor? Before we dive in, let me […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Post-cardiac arrest management https://emcrit.org/pulmcrit/post-arrest/ https://emcrit.org/pulmcrit/post-arrest/#comments Wed, 05 Dec 2018 14:35:50 +0000 http://emcrit.org/?p=455859 Post-cardiac arrest management has undergone substantial revisions within the past several years, particularly with regards to temperature management.  This remains an area of active controversy and investigation, with the TTM-2 trial currently underway.  Although equipoise still exists, this chapter describes a streamlined 36C approach which is based on evidence, guidelines, and experience with various strategies. […]

EMCrit Project by Josh Farkas.

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PulmCrit- Alpha-2 agonists: clonidine, guanfacine, lofexidine, and KetaDex https://emcrit.org/pulmcrit/ketadex/ https://emcrit.org/pulmcrit/ketadex/#comments Mon, 03 Dec 2018 13:50:06 +0000 http://emcrit.org/?p=455808 Dexmedetomidine is an intravenous alpha-2 agonist used as a sedative infusion.  It has some uniquely useful properties, particularly that it doesn’t suppress respiration (allowing it to be safely used in non-intubated patients).  The main drawbacks of dexmedetomidine are logistic:  it is expensive and can be administered only as an IV infusion within an ED or ICU.  Oral clonidine offers some similar benefits compared to dexmedetomidine, without these logistic constraints.

EMCrit Project by Josh Farkas.

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The Dantastic Mr. Tox & Howard – S02E05 – Don’t Call Her Czarina https://emcrit.org/toxhound/dmths02e05-czarina/ https://emcrit.org/toxhound/dmths02e05-czarina/#respond Thu, 29 Nov 2018 19:15:30 +0000 https://emcrit.org/?p=455772 The Opioid Crisis with UMass Chief Opioid Officer, Dr. Kavita Babu Join Dan (@drusyniak) &Howard (@heshiegreshie) as they welcome the first Chief Opioid Officer at UMass Memorial Health Care, Dr. Kavita Babu (@kavitababu) and talk about tackling the opioid crisis as toxicologists from boots on the ground to the halls of government. Get involved and […]

EMCrit Project by Tox & Hound.

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EMCrit Podcast 237 – Vent & PreVENT – An Update https://emcrit.org/emcrit/vent-prevent/ https://emcrit.org/emcrit/vent-prevent/#comments Wed, 28 Nov 2018 19:39:36 +0000 http://emcrit.org/?p=455055 More on Vents

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/vent-prevent/feed/ 4 More on Vents PreVENT Trial

* PreVENT Trial
* The Bottom Line on the PreVENT Study

Dominating the Vent Series

* EMCrit Lecture – Dominating the Vent: Part I
* EMCrit Lecture – Dominating the Vent: Part II
* Response to Letters on my Mechanical Ventilation Article in the Ann Emerg Med

PRVC Refs

* A rabbit study1
* PC vs. PRVC in Brain Injury Patients2
* Work of Breathing Analysis
* Small Study demonstrating that you are not getting the Vt you think you are3
* Small Crossover Trial4

Now on to the Podcast

References




1.
Porra L, Bayat S, Malaspinas I, et al. Pressure-regulated volume control vs. volume control ventilation in healthy and injured rabbit lung: An experimental study. Eur J Anaesthesiol. 2016;33(10):767-775. [PubMed]




2.
Schirmer-Mikalsen K, Vik A, Skogvoll E, Moen K, Solheim O, Klepstad P. Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial. Neurocrit Care. 2016;24(3):332-341. [PubMed]




3.
Kallet R, Campbell A, Dicker R, Katz J, Mackersie R. Work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome: a comparison between volume and pressure-regulated breathing modes. Respir Care. 2005;50(12):1623-1631. [PubMed]




4.
Guldager H, Nielsen S, Carl P, Soerensen M. A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure. Crit Care. 1997;1(2):75-77. [PubMed]



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Scott D. Weingart, MD clean 24:31
IBCC chapter & cast: Meningitis and encephalitis https://emcrit.org/pulmcrit/meningitis-2/ https://emcrit.org/pulmcrit/meningitis-2/#comments Wed, 28 Nov 2018 11:44:48 +0000 http://emcrit.org/?p=455732 Severe CNS infections are a bit of an orphan disease in critical care.  Unlike more common neurologic disorders (e.g. stroke), CNS infections are too rare to recruit lots of patients into RCTs.  Consequently, conventional treatment of these disorders lags decades behind other neurologic disorders (e.g. in terms of optimizing cerebral perfusion pressure).  Principles of neurocritical […]

EMCrit Project by Josh Farkas.

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Tox and Hound – The Worst of Both Worlds https://emcrit.org/toxhound/worst-of-both-worlds/ https://emcrit.org/toxhound/worst-of-both-worlds/#respond Mon, 26 Nov 2018 17:02:13 +0000 https://emcrit.org/?p=455675 A very special welcome to our newest hound, Jeanna Marraffa, PharmD, DABAT! You can learn more about her here . . . by Jeanna Marraffa Circa Feb 2012 Poison Center: “Um, Jeanna, there is a doc on the line that has a quick question for you. I’m going to send it through to your line.” […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Torsades de Pointes https://emcrit.org/pulmcrit/tdp/ https://emcrit.org/pulmcrit/tdp/#comments Wed, 21 Nov 2018 13:51:08 +0000 http://emcrit.org/?p=455493 Torsades de pointes is an uncommon cause of cardiac arrest.  It is generally quite treatable, but if treated inadequately it will often recur (in some cases leading to repeated salvos of ventricular tachycardia, one form an electrical storm).  A structured approach incorporating a pre-emptive protocoled magnesium infusion is generally quite effective. The IBCC chapter is […]

EMCrit Project by Josh Farkas.

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IBCC: Guide to supportive care in critical illness https://emcrit.org/pulmcrit/guide/ https://emcrit.org/pulmcrit/guide/#comments Mon, 19 Nov 2018 15:10:35 +0000 http://emcrit.org/?p=455440 This chapter gives an overview of how to provide high-quality supportive care to the sickest patients.  It summarizes about a dozen chapters within the IBCC.  This is intended as a quick guide for folks who don't work full-time in an ICU (e.g. residents rotating through the unit).  

EMCrit Project by Josh Farkas.

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IBCC chapter & cast: Hyperkalemia https://emcrit.org/pulmcrit/hyperk/ https://emcrit.org/pulmcrit/hyperk/#comments Wed, 14 Nov 2018 11:09:04 +0000 http://emcrit.org/?p=455366 Hyperkalemia is bread and butter critical care medicine.  However, the therapeutic approach has changed substantially within the past 5 years. Myths about kayexalate and normal saline have been exposed, allowing more effective therapies to take their place.  

EMCrit Project by Josh Farkas.

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EMCrit Wee – The Brindley Sessions – Followership https://emcrit.org/emcrit/followership/ https://emcrit.org/emcrit/followership/#comments Sun, 11 Nov 2018 22:14:31 +0000 http://emcrit.org/?p=451181 on followership

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/followership/feed/ 4 on followership

Another iteration of the Brindley Sessions:
The Article
Followership by Leung, Lucas, Brindley et al.
The Table

Figure 1: Robert Kelley’s Followership dimensions and styles, adapted from Kellerman (2008)1



in the podcast, the passive followers are described as yes-people
from: https://www.medicalprotection.org

More Sparks for Ideas

* Kelley's followership model with discussion
* A related discussion we published in BMJ
* A discussion on culture (including nations) by Geert Hofstede
* And a darn good book about cultivating "eulogy virtues" rather than "resume virtues"
* NOLS 4 leadership roles

Listen to the Rest of the Brindley Sessions
More from Peter
Now on to the Session...
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Scott D. Weingart, MD clean 26:48
IBCC chapter & cast: Delirium https://emcrit.org/pulmcrit/delirium/ https://emcrit.org/pulmcrit/delirium/#comments Wed, 07 Nov 2018 13:50:19 +0000 http://emcrit.org/?p=455234 Delirium occurs in about half of critically ill patients.  Some fairly simple measures may reduce the risk of delirium.  When it occurs, delirium is a diagnostic challenge because occasionally it can be a sign of undiagnosed underlying illness.  Treatment is challenging, with little evidence to support most of the standard therapies.

EMCrit Project by Josh Farkas.

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Tox and Hound – Twisted Interactions https://emcrit.org/toxhound/twisted-interactions/ https://emcrit.org/toxhound/twisted-interactions/#comments Wed, 07 Nov 2018 03:11:17 +0000 https://emcrit.org/?p=455223 by Andrew Stolbach     I. Depolarization Medicine should center on the patient, so I start this story with an anonymous person dropping dead.1 Perhaps this person first heard about the medication from a friend who raved about his new allergy pill. Then, the day of a routine doctor’s appointment, our patient saw an advertisement for […]

EMCrit Project by Tox & Hound.

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COMM CHECK: Sterile Cockpit https://emcrit.org/emcrit/comm-check-sterile-cockpit/ https://emcrit.org/emcrit/comm-check-sterile-cockpit/#comments Tue, 06 Nov 2018 20:30:48 +0000 http://emcrit.org/?p=455116 Post is coauthored by Ashley Keiler-Green MD, EM/Critical Care Attending, University of New Mexico School of Medicine This post is part of the COMM CHECK series on communication during resuscitation.   Silence is a source of great strength -Lao Tzu The Sterile Cockpit Communication is a key aspect of safe and efficient task execution in all high-risk […]

EMCrit Project by Mike Lauria.

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PulmCrit: No more antipsychotics for delirium? Not so fast! https://emcrit.org/pulmcrit/antipsychotics-delirium/ https://emcrit.org/pulmcrit/antipsychotics-delirium/#comments Mon, 05 Nov 2018 13:29:14 +0000 http://emcrit.org/?p=455111 Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness.  Before jumping into the results of this study, it will help to establish a couple of foundational principles.

EMCrit Project by Josh Farkas.

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PulmCrit- Does the HIGH trial debunk high-flow nasal cannula? https://emcrit.org/pulmcrit/pulmcrit-does-the-high-trial-debunk-high-flow-nasal-cannula/ https://emcrit.org/pulmcrit/pulmcrit-does-the-high-trial-debunk-high-flow-nasal-cannula/#comments Thu, 01 Nov 2018 13:01:45 +0000 http://emcrit.org/?p=455050 High-flow nasal cannula (HFNC) has become popular for the hypoxemic respiratory failure, driven partially by the FLORALI trial.1  Recently, the HIGH trial evaluated the ability of HFNC to reduce mortality among immunocompromised patients with acute hypoxemic respiratory failure.2  HFNC failed to improve mortality or significantly reduce intubation rates. Popular narrative about this trial A common […]

EMCrit Project by Josh Farkas.

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EMCrit 236 – George Kovacs on EVLI Airway Incrementalization https://emcrit.org/emcrit/evli/ https://emcrit.org/emcrit/evli/#comments Wed, 31 Oct 2018 17:45:25 +0000 http://emcrit.org/?p=455075 Approach to steps of laryngoscopy/intubation

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/evli/feed/ 4 Approach to steps of laryngoscopy/intubation
A video lecture from my friend and airway guru,  Prof. George Kovacs. He has been obsessed with airway for decades. This lecture discusses breaking down the steps of airway management into chunks.
George's Site

* AIME Airway

More from George on EMCrit

* The Psychologically Difficult Airway by George Kovacs
* Definitive Emergent Awake Intubation with George Kovacs
* Airway Things I Learned from George Kovacs at the NYC Airway Course
* Antifragile in EM by George Kovacs

Now on to the Vodcast...


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Scott D. Weingart, MD clean 22:07 yes
IBCC chapter & cast: Anemia & transfusion targets https://emcrit.org/pulmcrit/transfusion/ https://emcrit.org/pulmcrit/transfusion/#comments Wed, 31 Oct 2018 12:26:30 +0000 http://emcrit.org/?p=455063 Most patients in the ICU will become anemic.  This chapter explores prevention, evaluation, and treatment of anemia in the ICU.  Causes of new-onset anemia in the ICU are distinct from the causes of anemia seen in the outpatient clinic, so the approach should be appropriately tailored to the critical care environment.   

EMCrit Project by Josh Farkas.

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PulmCrit- SUP-ICU: Is pantoprazole the elixir of life? Should it be? https://emcrit.org/pulmcrit/sup-icu/ https://emcrit.org/pulmcrit/sup-icu/#comments Tue, 30 Oct 2018 11:43:13 +0000 http://emcrit.org/?p=455011 SUP-ICU is a massive, modern RCT of stress ulcer prophylaxis (SUP) in the ICU. With 3298 patients, it is larger than many meta-analyses of SUP. Its primary mortality endpoint is deeply flawed.  However, the study still provides a wealth of information about SUP in the ICU.

EMCrit Project by Josh Farkas.

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CC Nerd-The Case of the Subjective Truth https://emcrit.org/emnerd/cc-nerd-the-case-of-the-subjective-truth/ https://emcrit.org/emnerd/cc-nerd-the-case-of-the-subjective-truth/#respond Sun, 28 Oct 2018 15:21:05 +0000 http://emcrit.org/?p=454989 A recent post examining the utility of cricoid pressure and how to interpret non-inferiority trials stimulated discussion on Bayesian analysis and the question of whether a formal quantitative analysis is necessary or if an informal qualitative assessment is adequate. A recent reanalysis of the EOLIA trial published in JAMA by Goligher et al1 allows us to […]

EMCrit Project by Rory Spiegel.

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IBCC chapter & cast: Acute pancreatitis https://emcrit.org/pulmcrit/pancreatitis/ https://emcrit.org/pulmcrit/pancreatitis/#comments Thu, 25 Oct 2018 19:29:15 +0000 http://emcrit.org/?p=454895 Management of severe pancreatitis has remained in a state of controlled chaos and persistent debate for years (mirroring evolution in our treatment of septic shock).  This confusion shows no signs of abating in the near future.  This chapter explores a reasonable approach to pancreatitis, with the caveat that there is very little evidence available to guide our combat against this challenging foe.  

EMCrit Project by Josh Farkas.

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Tox and Hound – Dust To Dust https://emcrit.org/toxhound/dust-to-dust/ https://emcrit.org/toxhound/dust-to-dust/#comments Tue, 23 Oct 2018 02:38:39 +0000 http://emcrit.org/?p=454855 by Howard Greller Sudden sniffing death and myocardial sensitization I will show you fear in a handful of dust. – T.S. Eliot Little Johnny was having a hard time. Dumped by his girlfriend of eight glorious weeks, he was despondent. There wasn’t any alcohol in the house, and he didn’t have a fake ID or the […]

EMCrit Project by Tox & Hound.

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PulmCrit- Ketamine for alcohol withdrawal? https://emcrit.org/pulmcrit/ketamine-alcohol-withdrawal/ https://emcrit.org/pulmcrit/ketamine-alcohol-withdrawal/#comments Mon, 22 Oct 2018 11:55:42 +0000 http://emcrit.org/?p=454836 Recent publications have explored the role of ketamine in alcohol withdrawal.  Ketamine undoubtedly has some outstanding properties, which make it well suited for  this task.  The challenge is integrating ketamine into a unified, coherent treatment strategy. 

EMCrit Project by Josh Farkas.

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EM Nerd-The Case of the Inferior Superiority https://emcrit.org/emnerd/em-nerd-the-case-of-the-inferior-superiority/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-inferior-superiority/#comments Thu, 18 Oct 2018 18:26:05 +0000 http://emcrit.org/?p=454766 A perfect trial would require minimal statistical tools to assist in its analysis. Such a trial would be so large that the sample approached the true likeness of the broader population it intended to emulate, thus the risk of sampling error would be minimal. The confidence intervals surrounding the point estimates would be so minute, […]

EMCrit Project by Rory Spiegel.

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EMCrit #235 – Cardiac Arrest Science with Zack Shinar https://emcrit.org/emcrit/cardiac-arrest-science/ https://emcrit.org/emcrit/cardiac-arrest-science/#comments Wed, 17 Oct 2018 16:17:05 +0000 http://emcrit.org/?p=451613 Cardiac Arrest Science

EMCrit Project by Scott Weingart.

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Today, I get to speak with my buddy Zack Shinar about soem cardiac arrest science.

Questions Discussed

Is there a no-flow time past which there is no hope for survival?
If there is, how do we know the pt was actually fully no-flow--are we are conflating no-cpr for no flow?
What is the survival limit on low flow time?
VF survival is not linear across time. What happens to that number if you strip out all the 1-2 shock v-fib (real comparator for ecmo right?
Who are the few (5%) of non-ecpr patients who survive after 30 minutes of CC?
Effect of Transient ROSC on outcome data






Current Cardiac Arrest Assumptions – mantras needs changing

* Cardiac arrest rhythms have overlap but are very different disease
* Termination of Resuscitation (TOR) is outdated
* Pre-hospital prognostication needs an increase in sophistication

Some Literature on the Stuff Spoken About



* Asystole in patients with wearable ICDs are much better than historical1
* Shockable rhythm patients can have neurologically intact survival with CPR out to 47 minutes (mRS 0-3)2
* When Should EMS Transfer-Transport for ECPR should be considered between 8 to 24 minutes of professional on-scene resuscitation, with 16 minutes balancing the risks and benefits of early and later transport. Earlier transport within this window may be preferred if high quality CPR can be maintained during transport and for those with initial non-shockable rhythms.3 50%of ROSC would be captured at 8 minutes and 90% by 16 minutes.
* Reynolds et al. found similar data with 21 minutes being the 90% capture mark.4
* PEA should prob. not be an exclusion for ECMO, they can have a 23% neuro intact survival in this paper.5
* Wake County Data Packet
* Rate of Brain Death and organ donation, possibly another reason field termination in the field is a bad strategy in viable cohorts
* Adnet et al. on No-Flow and Low-Flow Durations

Other EMCrit Links of Interest

* Cardiac Arrest Update
* EMS Field Decisions in Cardiac Arrest with Howie Mell

Sign up for REANIMATE6 before tickets sell out
REANIMATEconference.com
Now on to the Podcast...

References




1.
Liang J, Bianco N, Muser D, Enriquez A, Santangeli P, D’Souza B. Outcomes after asystole events occurring during wearable defibrillator-cardioverter use. World J Cardiol. 2018;10(4):21-25. [PubMed]




2.
Reynolds J, Grunau B, Rittenberger J, Sawyer K, Kurz M, Callaway C. Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest: Implications for Prolonging or Terminating Resuscitation. Circulation. 2016;134(25):2084-2094. [PubMed]




3.
Grunau B, Reynolds J, Scheuermeyer F, et al. Relationship between Time-to-ROSC and Survival in Out-of-hospit...]]>
Scott D. Weingart, MD clean 33:06
IBCC chapter & cast: severe heart failure & cardiogenic shock https://emcrit.org/pulmcrit/heart-failure/ https://emcrit.org/pulmcrit/heart-failure/#comments Wed, 17 Oct 2018 12:46:00 +0000 http://emcrit.org/?p=454739 Management of severe heart failure and cardiogenic shock is difficult.  There is a notable lack of high-quality evidence regarding the sickest patients.  Treatment strategies validated among more stable patients may not be applicable to the most unstable heart failure patients.   

EMCrit Project by Josh Farkas.

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Tox and Hound – Oh, the Nerve! https://emcrit.org/toxhound/the-nerve/ https://emcrit.org/toxhound/the-nerve/#comments Mon, 15 Oct 2018 14:15:47 +0000 http://emcrit.org/?p=454665 by Dan Rusyniak     OK, I am going to dive into this whole Russia controversy. Now before you go getting all political on me, I am not talking about the Muller probe. I am talking about the recent suspected poisoning of a former Russian Spy in England. While Russia has been the prime culprit […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast – Hypoglycemia https://emcrit.org/pulmcrit/hypoglycemia/ https://emcrit.org/pulmcrit/hypoglycemia/#comments Wed, 10 Oct 2018 10:48:25 +0000 http://emcrit.org/?p=454580 Severe hypoglycemia can be scary, especially when the patient isn't responding to front-line therapies (e.g. IV dextrose).  However, some unconventional tools and an organized approach can make this extremely manageable.

EMCrit Project by Josh Farkas.

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Tox and Hound – Toxicology’s Shapeshifter: Synthetic Cannabinoids https://emcrit.org/toxhound/tox-and-hound-synthetic-cannabinoids/ https://emcrit.org/toxhound/tox-and-hound-synthetic-cannabinoids/#comments Tue, 09 Oct 2018 14:03:39 +0000 http://emcrit.org/?p=454590 by Jeff Lapoint July, 2010. 3:14 am. “Jeff, I got a liddle case for ya”, said the voice of Lou (named changed), the very New York C-SPI from the Poison Center. “917-555-. . .” He continued to rattle off a phone number. “Dude, give me more than that”, I begged. I was a new fellow, […]

EMCrit Project by Tox & Hound.

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Tox and Hound – The Dantastic Mr. Tox & Howard – S02E04 – The Bloody Mess https://emcrit.org/emcrit/toxandhound-dmths02e04-the-bloody-mess/ https://emcrit.org/emcrit/toxandhound-dmths02e04-the-bloody-mess/#comments Mon, 08 Oct 2018 16:54:17 +0000 http://emcrit.org/?p=454552 The synthetic cannabinoid / brodifacoum outbreak with Dr. Steve Aks Join Dan (@drusyniak) &Howard (@heshiegreshie) as they chat with Dr. Steve Aks as they talk about one of the more concerning toxicologic outbreaks in recent memory – the exposure to brodifacoum through synthetic cannabinoid use. Although still ongoing, this crisis highlights the importance of teamwork […]

EMCrit Project by Tox & Hound.

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PulmCrit- Alcohol Withdrawal: One order to sedate them all https://emcrit.org/pulmcrit/phenobarbital-oks/ https://emcrit.org/pulmcrit/phenobarbital-oks/#comments Mon, 08 Oct 2018 10:47:14 +0000 http://emcrit.org/?p=454508 I should do a formal retrospective cohort study on this, but I don’t have time.  Fortunately, the ICU group at Northshore/Long Island Jewish has done exactly that.

EMCrit Project by Josh Farkas.

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EMCrit 234 – Pardon Me, I Couldn’t Help but Overhear or How to go from being an Ass-hole to an AYS-hole on Twitter https://emcrit.org/emcrit/ays-holes/ https://emcrit.org/emcrit/ays-holes/#comments Wed, 03 Oct 2018 19:21:07 +0000 http://emcrit.org/?p=454458 Are you saying?...

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/ays-holes/feed/ 9 Are you saying?...
* Jenny Rudolph on WTF



* Pew Center Article
* Types of People to Hate on Facebook


Now on to the Podcast...
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Scott D. Weingart, MD clean 25:43
IBCC chapter & cast: Bradycardia https://emcrit.org/pulmcrit/bradycardia/ https://emcrit.org/pulmcrit/bradycardia/#comments Wed, 03 Oct 2018 13:36:20 +0000 http://emcrit.org/?p=454444 Bradycardia emergencies are uncommon, but these cases can go sideways fast.  An appropriately aggressive approach is needed to avoid cardiac arrest.  Sometimes the answer is as simple as the appropriate epinephrine dose.  

EMCrit Project by Josh Farkas.

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Tox and Hound – Snakes! Why’d it have to be SNAKES? https://emcrit.org/toxhound/snakes-whyd-it-have-to-be-snakes/ https://emcrit.org/toxhound/snakes-whyd-it-have-to-be-snakes/#comments Mon, 01 Oct 2018 15:52:20 +0000 http://emcrit.org/?p=454361 by Meghan Spyres Unless you suffer the over appreciated and never-ending summer of southern California, the warm weather season is winding down and fall is settling in. Though many will lament the end of iced coffees, sunny beaches, and carefree summer attire, for many toxicologists, we will quietly lament the end of snake season. Perhaps […]

EMCrit Project by Tox & Hound.

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EM Nerd-An Addendum to the Case of the Non-inferior Inferiority https://emcrit.org/emnerd/em-nerd-an-addendum-to-the-case-of-the-non-inferior-inferiority/ https://emcrit.org/emnerd/em-nerd-an-addendum-to-the-case-of-the-non-inferior-inferiority/#comments Mon, 01 Oct 2018 01:43:17 +0000 http://emcrit.org/?p=454375 Until recently the management of acute appendicitis has lay squarely in the hands of the surgeon. But there is a growing body of evidence examining the use of antibiotics alone in uncomplicated appendicitis. Most of the data exploring this question has found that the majority of patients treated with antibiotics alone will avoid surgery in […]

EMCrit Project by Rory Spiegel.

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IBCC chapter & cast: community-onset pneumonia https://emcrit.org/pulmcrit/pneumonia/ https://emcrit.org/pulmcrit/pneumonia/#comments Thu, 27 Sep 2018 11:17:14 +0000 http://emcrit.org/?p=454284 Sir William Osler called pneumonia "the captain of the men of death."  Over a century later, pneumonia remains the leading cause of infectious death in the developed world.  

EMCrit Project by Josh Farkas.

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PulmCrit- Solving the OPTALYSE PE riddle: We’re dosing tPA wrong https://emcrit.org/pulmcrit/pulmcrit-solving-the-optalyse-pe-riddle-were-dosing-tpa-wrong/ https://emcrit.org/pulmcrit/pulmcrit-solving-the-optalyse-pe-riddle-were-dosing-tpa-wrong/#comments Mon, 24 Sep 2018 11:00:08 +0000 http://emcrit.org/?p=454138 Occasionally in science we encounter a truly bizarre result.  Our natural inclination is to ignore the bizarre result.  It’s jarring.  It creates cognitive dissonance, challenging our understanding of the world.  However, struggling to understand the bizarre result can reset our perspective.  It’s often the bizarre, unexpected result that changes everything. 

EMCrit Project by Josh Farkas.

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EMCrit – How Do You Know You Are Actually Good at Airway Management by Laura Duggan https://emcrit.org/emcrit/how-do-you-know-you-are-actually-good-at-airway-management/ https://emcrit.org/emcrit/how-do-you-know-you-are-actually-good-at-airway-management/#comments Sat, 22 Sep 2018 17:11:15 +0000 http://emcrit.org/?p=454082 Debrief Every Airway

EMCrit Project by Laura Duggan.

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Tox and Hound – Fellow Friday – Cyanomythology: The Toxicomythology of Cyanide Poisoning https://emcrit.org/toxhound/cyanomythology/ https://emcrit.org/toxhound/cyanomythology/#comments Fri, 21 Sep 2018 17:19:34 +0000 http://emcrit.org/?p=454031 Binding to Cytochrome Oxidase and the Mysterious Cyanhemoglobin by Steven Curry, M.D. Banner – University Medical Center Phoenix University of Arizona College of Medicine – Phoenix Phoenix, AZ @SteveCurryMD Every toxicology fellow learns about cyanide. But not all of what they learn is necessarily correct. As a resident, I was taught that the CN– ion […]

EMCrit Project by Tox & Hound.

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EMCrit 233 – EMCrit Failed Airway Algorithm 2018 from ResusTO https://emcrit.org/emcrit/failed-airway-algorithm-2018/ https://emcrit.org/emcrit/failed-airway-algorithm-2018/#comments Wed, 19 Sep 2018 16:11:24 +0000 http://emcrit.org/?p=453905 Remixed and Better for 2018

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/failed-airway-algorithm-2018/feed/ 36 Remixed and Better for 2018 Why First Pass Success?
Best review article - first-shot-is-the-best-shot

Each Attempt Makes Things Worse

Hasegawa et al. showed at 3 attempts, things got bad (Ann Emerg Med 2012;60:749)

Sackles JC et al. showed that >1 attempt radically increased complications (ACADEMIC EMERGENCY MEDICINE 2013; 20:71–78)

Mort demonstrated this in the ICU, after two attempts risk of crit desat (70%) is huge and assoc. with cardiopulm arrest (Anesth Analg 2004;99:607)

Mort has further elaboration re: the dangers of intubation in the critically ill (J Inten Care Med 2007;22(4):208)

Heffner et al. showed a 4% cardiac arrest rate in ED intubations (Incidence and factors associated with cardiac arrest complicating emergency airway management. Resus 2013)

Duggan showed >1 attempt = badness
Learning Curve for Laryngoscopy
Best review of lit is at Openairway
EMCrit Failed Airway Algo V2.0

Bug the ResusTO Folks to Do the Course Again
ResusTO
Blade Views by Nick Chrimes

Now on to the Vodcast...


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Scott D. Weingart, MD clean 37:14 yes