Richard Byrne, MD
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!
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!
Last Thursday was the yearly Cooper EM residency retreat at the shore in Avalon, NJ. In addition to some spectacular teaching tips on summer emergencies, we had some great small group discussion and role-playing regarding one of the toughest (and least discussed) aspects of our jobs: difficult discussions with consultants, admitting physicians, and patients. Read on for some great interpersonal communications tips (and some pics of the Cooper EM residents hard at work).
Intubation has traditionally been performed with patients in the full supine position. Recent data suggests that elevation of the head of the bed may be more effective during preoxygenation before intubation. Check out this summary of a paper from Anesthesia that put this idea to the test!
Anatomic landmarks followed by a "blind" stick is currently the standard practice for performing bedside lumbar punctures, but with increasing use and ease of ultrasound, could we one day see lumbar punctures follow in the footsteps of central line placement?
With summer in full swing now, swimming emergencies are bound to increase. A recent surge in media coverage may have raised many questions about the phenomenon known as “dry drowning." Variations in nomenclature regarding drowning can lead to confusion and imprecise terminology. Check out this post for a quick review: