from a listener
High-flow nasal cannula for apneic oxyventilation
0 Introduction 0 Last summer I wrote a postabout preoxygenation and apneic oxygenation using high-flow nasal cannula (HFNC). At that point there was no evidence supporting it, so the post was based primarily on the physiology of HFNC. Recently two papers were published supporting the use of HFNC for preoxygenation and apneic oxygenation (Patel 2015, […]
The Case of Dubious Squire
I often get the sense that the makers of many biomarkers envision us as helpless damsels in distress drowning in an icy pond or trapped in a monumental tower with no obvious means of descent. I imagine they think in our desperate grasps for aid, we will cling to whatever assistance they may offer, independent […]
EMCrit Wee – The RLA and the Slope of Resuscitation
The RLA and Resus Graphs
Hemodynamic access for the crashing patient: The dirty double
0 0 Introduction with a case 0 A 75-year-old man presents in transfer to the ICU for management of bradycardia and hyperkalemia. His history is notable for hypertension with chronic use of an ACE-inhibitor. He developed gastroenteritis due to endemic Norovirus some days prior. Today he presented to the outside hospital with hypotension and […]
The Adventure of the Second Stain Continues
The CT-LP (lumbar puncture) diagnostic pathway has been a permanent fixture in the arsenal of the Emergency Physician for what seems like an eternity. Steadfast in its dependability, for many generations, the LP was a necessity for Emergency Physicians to safely exclude the diagnosis of subarachnoid hemorrhage (SAH). And yet, rarely a moment has passed over […]
Five pearls for the dyspneic patient with Guillain-Barre Syndrome or Myasthenia Gravis
0 Introduction 0 Guillain-Barre Syndrome (GBS) and Myasthenia Gravis (MG) are common causes of acute weakness. About 25% of these patients may develop respiratory failure requiring intubation, so a major concern is determining who requires ICU-level monitoring and whether intubation should be performed. Ideally it would be possible to predict with 100% accuracy which patients […]
EMCrit 144 – The PROPPR trial with John Holcomb
The biggest news in the management of traumatic hemorrhage is the PROPPR Trial. Want to hear from the lead author?
Thrombectomy plus thrombolysis for acute stroke: A word of caution
Introduction: Problem of the premature standard of care 0 This issue has previously been discussed with regards to heparin and thrombolysis for submissive pulmonary embolism. Heparin was adopted as treatment for PE before the era of evidence-based medicine. Although heparin prevents further clot formation, it probably doesn’t have any immediate effect on hemodynamic stability. Regardless, […]
EMCrit 143 – Hemodynamic Management of Massive Pulmonary Embolism (PE)
Hemodynamic Management of Massive PE
The Adventure of the Cardboard Box Continues
For those whose beliefs are already firmly in favor of endovascular therapy for acute ischemic stroke, the publication of the MR CLEAN trial earlier this year and more recently the EXTEND-IA and ESCAPE trials only serve as a big fat, “I TOLD YOU SO!” For the perpetual disbelievers, each of these trials possesses enough flaws […]
The Adventure of the Blanched Soldier
So often in the management of the critically ill we are forced to choose between the lesser of two evils. The transfusion of blood products in the face of hemorrhagic shock is in some ways the best compromise of less than ideal choices. Every drop of resuscitative fluid given that does not mimic the […]
Treatment of ACEi-induced angioedema
Introduction 0 ACE-inhibitor induced angioedema (ACEI-AAG) accounts for about a third of angioedema cases presenting to the emergency department. ACE inhibitors are increasingly popular, with the new JNC 8 guidelines up-grading them to a first-line drug for hypertension. Thus, ACEI-AAG may represent a growing problem. Unfortunately, this is often treated incorrectly, with a medication regimen […]
Approaching undifferentiated cardiopulmonary failure: Which tests are most useful?
0 Introduction 0 Recently point-of-care ultrasonography (POCUS) has risen in prominence within acute care medicine. It has been shown to provide immediate and critical information about a variety of conditions ranging from nephrolithiasis to pulmonary edema. However, POCUS is not without its critics, who point out weaknesses including detection of incidental findings (i.e., small […]
Three myths about Plasmalyte, Normosol, and LR
0 Introduction: Selecting the best balanced crystalloid 0 About six months ago, Genius General Hospital added Normosol to its formulary. For those of you not familiar with Normosol, it is produced by Hospira and is essentially a generic version of Plasmalyte by Baxter (table below). Although most evidence has been obtained with Plasmalyte, this is […]
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