Article: Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm 

Submitted by Alyse Volino, MD

A 55 yo F with a history of untreated hypothyroidism presents to the ED with fatigue, SOB, abdominal distension and lower extremity edema.

Submitted by Eric Chavis, MD

Lung protective ventilation limiting tidal volume and plateau pressure improves survival in ARDS. The application of positive end-expiratory pressure (PEEP) further stabilizes the lung by preventing alveolar collapse during expiration, thereby reducing cyclic atelectasis. However, the optimal approach to PEEP titration to minimize ventilator-induced lung injury (VILI) has not been delineated. The EPVent-1 trial demonstrated that esophageal pressure-guided PEEP titration was feasible and safe with a trend toward increased survival and improved oxygenation in mild to moderate ARDS. However, interest in esophageal manometry in ARDS was deflated by the more recent EPVent-2 trial demonstrating no improvement in a composite outcome incorporating mortality and ventilator-free days in patients with moderate to severe ARDS. A new randomized control trial published last week by Wang et al. examined the role of esophageal manometry-guided PEEP titration in a novel subset of severe ARDS patients treated with VV ECMO. 

Submitted by Emily Damuth, MD

Not a common inner-city emergency, but certainly something you'll see elsewhere. Removing an embedded fishhook can be surprisingly tricky - here are a few methods to know!

Submitted by Alison Jaworski, MD