Category Archives: Emergency Medicine

EWWW!

I found two interesting papers in EMJ. Both recently published. If you intubate a fresh frozen cadaver and ventilate you will get a transient capnography trace very similar to a trace from a living patient. I had heard about it before but … Continue reading

Posted in Airway management, Cardiology, CPR, Emergency Medicine | 1 Comment

WHAT THE HELL I AM DOING? I AM ENGORGING A VEIN IS WHAT I AM DOING!

I’m not sure where this fits in, in this age of ultrasounding everything, but there is an interesting short report in EMJ. It describes a simple technique to achieve IV access in patients where the periphery is shut down.  A typical scenario … Continue reading

Posted in Emergency Medicine, Prehospital Medicine | 3 Comments

THE ONE-TWO PUNCH

Interesting case report on cardiac arrest patient with refractory VF. Shocked 7 times – with a change in pad location. No luck. For the 8th shock, they hooked the patient up to a second defibrillator, and shocked him sequentially. One … Continue reading

Posted in CPR, Emergency Medicine | 3 Comments

E-CPR STRIKES AGAIN

ECMO for cardiac arrest, E-CPR, has been shown several times to increase survival more than any other intervention we have available. Here’s yet another retrospective study to support the findings in previous trials (links at end of post). Survival with … Continue reading

Posted in Cardiology, ECMO, Emergency Medicine | 11 Comments

IO DRUGS AS QUICK AS IV

IO needles are always said to be able to deliver any drug, and with the same speed and onset as their IV cousins – also in critical patients. Most of use don’t really trust that fully, I think. The ones … Continue reading

Posted in Anesthesia, Emergency Medicine, Trauma | Leave a comment

PERIPHERAL NORADRENALINE

Peripheral noradrenaline (or norepinephrine), or any peripheral pressor, is shunned in many centers. High doses can cause gangrene. If extravasated, it can cause tissue necrosis. But is this a big risk? Also, weighing against the risks of CVC or delayed … Continue reading

Posted in Anesthesia, Emergency Medicine, Intensive Care | 5 Comments

CODE BROWN: COMBATIVE AND BLEEDING

I’ve had combative patients in my ER lots of times. Combative enough to warrant sedation or anaesthesia. And bleeding patients. Serious bleeding. Lots of times. But not the extremes of both at the same time.

Posted in Code Brown, Emergency Medicine, Trauma, Ultrasound | 11 Comments

EGDT IS DEAD, LONG LIVE EGDT

And so the EGDT trilogy is complete. The results of the ProMISe trial was published, after we’ve recently had the results from the ARISE and ProCESS trials. They all compared EGDT (Early Goal-Directed Therapy) to “standard care”. And they were … Continue reading

Posted in Emergency Medicine, Infectious diseases, Intensive Care | 5 Comments

TEE DURING CARDIAC ARREST

Transesophageal echocardiography (TEE or TOE) used to be the domain of cardiologists. It has lately seeped into other areas of medicine where hemodynamic evaluation is crucial. ICU’s and occasionally OR’s use them even for non-cardiac surgery. But the TEE probe … Continue reading

Posted in AHLR, Emergency Medicine, Ultrasound | 2 Comments

THUNDERSTORM ASTHMA

I always thought ‘thunderstorm asthma’, localised epidemics of asthma associated with thunderstorms, was semi-factoid.  Not so.  Apparently, thunderstorms do cause asthma spikes in asthma ED attendance. This is elegantly shown in a recent Emerg Med J.

Posted in Emergency Medicine | 1 Comment