Richard Byrne, MD

#EMconf - COPD management pearls!

You are caring for a sick patient with an acute COPD exacerbation. What O2 sat should you target? What meds should you give? If you have to intubate, what are the issues you'll have to deal with? This week we glean some valuable management pearls for the management acute COPD exacerbations from this month's Internal Medicine module at Cooper.

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Advanced Practice - Got a rhythm and it won't let go....

A patient presents in ventricular tachycardia with a blood pressure of 90 systolic. He is diaphoretic and complaining of chest pain. You decide to attempt electrical cardioversion and it fails. You attempts again....and again....and again....without success. You realize this is no ordinary VT...this is electrical storm. Read on for pearls on how to deal with this frightening and deadly condition.

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#EMconf: Acute SOB

This week at our EM/Cardiology interdisciplinary conference, Dr. Lisa Filippone presented a case of a 75 year old male who presented with acute SOB.  This patient presented to the ED 3 days after a NSTEMI with hypotension and hypoxia.  No injury pattern was identified on his ecg but his CXR was consistent with pulmonary edema.  A bedside ECHO was performed that revealed the diagnosis....

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Advanced Practice - Discharge Afib with RVR from your ED!

atrial fibrillation

Ever wonder if all of your patients presenting with recent onset (<48 hrs) atrial fibrillation and a rapid ventricular response really need to be admitted? Is there evidence of a safe and effective treat and street algorithm that EM physicians can employ? Read on for a review of the Ottawa Aggressive Protocol for rapid afib that enables discharge of 97% of patients!

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Advanced Practice: Airway Mastery Series! DL vs VL for Airway Management in the ED

This is a summary of a portion of Dr. Byrne's talk on airway management presented at the August ResusEM conference at Cooper Medical School of Rowan University. This week we seek to answer the question: is video laryngoscopy superior to direct laryngoscopy for improved first pass success and decreased complication rates? Yes. Yes it is. Read on!

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Advanced Practice - Airway Mastery Series! Preoxygenation strategies

This post is a a summary of a portion of Dr Byrne's airway talk from last month's ResusEM conference at the Cooper Medical School of Rowan University. New techniques for preoxygenation before intubation can help to prolong time to desaturation and make this potentially dangerous procedure safer than ever!

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#EMconf: The (Dis)Utility of the Urine Drug Screen

The Urine Drug Screen (UDS) is a commonly used test in the emergency department, however there are many shortcomings that limit its diagnostic utility. The Urine Drug Screen is exactly that – a SCREENing and not a confirmatory test!  This week Dr. Lauren Murphy educated us on: 1) the potential false positives and negatives of the UDAS and 2) the detection times that drug metabolites are at a concentration in the urine to trigger a positive result (cutoff value).  Read ahead for the reference tables!    

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