You have a patient in cardiac arrest getting high quality CPR with an initial rhythm of pulseless VT that has been defibrillated three times and received a total of 3 mg of epinephrine and a loading dose of 300 mg of amiodarone. As you continue ACLS, the patient remains in VT. Are there alternative treatments to consider?
Submitted by Tom Sewatsky, MD
Case: A 34 year old female with no PMHX presents to the ED with unilateral right lower extremity swelling, dyspnea, and moderate pleuritic chest pain. Vitals: BP 130/65, HR 68, RR 20, SPO2 89% on room air, Temp 37.8. A CT finds evidence of PE bilaterally at the segmental level. BNP and troponin are both mildly elevated. Point of care cardiac ultrasound shows mild RV dilation. After interviewing the patient, you don’t identify any contraindications to anticoagulation. Pregnancy testing is negative. Her renal function is normal. You consider what is the preferred agent for anticoagulation in this patient.Read more
Submitted by Lars-Kristofer Peterson, MD
Bradycardia is defined as a heart rate of less than 60 BPM. In the ED, we may not always have the time to stop to consider the etiology of bradycardia after we have stabilized our patient (and after we likely already consulted cardiology!) Having a thoughtful approach to the differential diagnosis for bradycardia can be extremely helpful in treating the underlying cause. The next time a bradycardic patient presents to your ED, think to yourself, “The Brady Bunch is on a DIET.”
Submitted by Amanda Curry, MD