Sat, 08/22/2020 - 5:00am

 

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Fri, 08/21/2020 - 8:30pm

EMS calls ahead with reports of an adult patient in respiratory distress.  They are concerned the patient will need to be intubated on arrival.  Recognizing the name, you pull up a previous chart and review the patient’s history.  You realize this is their 10th presentation this year and on reviewing their most recent oncology note you note their oncologist has recommended they consider hospice due to end stage malignancy without further treatment options.  The patient arrives, is in distress, and does not have capacity but can be temporized by NIPPV while decision making occurs.  Their power of attorney comes to the hospital soon after but states they never got around to establishing an advanced directive. How should you approach this conversation?

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Thu, 08/20/2020 - 6:00am

Question: Is point of care ultrasound (POCUS) in the ED as accurate as CT for diagnosing small bowel obstruction (SBO)?

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Wed, 08/19/2020 - 6:58pm

A 55 yo M presents to the ED w/ thumb pain following an MVC. He states his car spun out of control and he felt the steering wheel slam into the webspace between his thumb and 2nd digit. Pain and swelling have worsened since the time of the accident. An xray is done and shown below.

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Tue, 08/18/2020 - 10:32am

EMS brings in a patient who was found down in his front lawn. They report he is dry and very hot to the touch, and has been unresponsive during transport. As you approach the resuscitation bay you quickly run down potential causes of a heat emergency and begin to think about the best way to treat this patient.....

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Mon, 08/17/2020 - 5:00am

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

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Sat, 08/15/2020 - 8:00am

55 year old femal

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Fri, 08/14/2020 - 6:07am

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.  

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Thu, 08/13/2020 - 6:00am

General:

  • Can be Alternating Current (AC) or Direct Current (DC)
  • Enormous amount of voltage
  • REVERSE TRIAGE: tend to patients in arrest first 

5 Mechanisms of Injury:

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Wed, 08/12/2020 - 12:10am

 

 

A 12 day old baby boy presents with vomiting

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