How do we manage a first time seizure? Let's review the basics here

Submitted by Lynn Manganiello, DO

Several drugs have been investigated in patients with ARDS, including epoprostenol, nitric oxide, statins, and methylprednisolone, but have not improved survival. Meduri et al. performed an RCT demonstrating that methylprednisolone was associated with a reduction in lung injury score and duration of mechanical ventilation. While not powered to evaluate mortality, this trial raised interest in the use of corticosteroid to mitigate inflammatory lung injury. The 2017 Guidelines from the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) recommend steroids for treatment of ARDS based on a meta-analysis of nine randomized controlled trials demonstrating reduction in markers of inflammation and duration of mechanical ventilation, although many of the trials had a small sample size and some were performed without lung protective ventilation. In March 2020, Villar et al. published the largest randomized control trial of corticosteroid therapy for moderate to severe ARDS investigating the impact of dexamethasone on survival and duration of mechanical ventilation.  

Submitted by Tom Sewatsky, MD

A 12 day old baby boy presents with vomiting

Submitted by Angela Ugorets, MD

Delivering bad news, such as concern for a new cancer diagnosis, is difficult in any setting. In the ED, we are often faced with additional challenges - limited information, time constraints, lack of established relationship with patients, and many others. Yet it is crucial we learn to do this well - here is some guidance to get started.