Modern immunizations in conjunction with better CT imaging has likely led to declining need for lumbar puncture in the emergency department to evaluate for meningitis and subarachnoid hemorrhage. This may contribute to physician discomfort with the procedure and lower likelihood of first attempt success. This study evaluated whether the addition of ultrasound guidance could increase first attempt success on infant lumbar puncture in the Emergency Department.
Richard Byrne, MD
Intubation is a potentially dangerous procedure which may result in rapid hemodynamic collapse and cardiac arrest in the critically ill. This week we summarize the results of a large retrospective study to determine the clinical factors associated with cardiac arrest after intubation.
A new class of medications for the management of diabetes (SGLT-2 inhibitors) is challenging our traditional notions of the diagnosis of diabetic ketoacidosis (DKA). Read on for quick pearls on when to suspect so called "euglycemic DKA" in the ED.
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.
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.
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....
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!
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!