Critical Care

Critically Appraised Topic: Does the timing of ECG acquisition post-ROSC for out of hospital cardiac arrests matter in identifying significant coronary lesions?

Dr. Amish Patel, D.O., dives into these two papers. 

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Critical Cases - Severely agitated DKA patient!

A 23 yo male with a hx of insulin dependent diabetes and recurrent admissions for DKA presents to the ED with complaints of diffuse body aches. He is acutely ill appearing, agitated, and combative with staff, demanding pain medication, entering other patients rooms, and screaming. Realizing that this patient is severely ill, you wonder how you will de-escalate or sedate this patient safely to enable life-saving care to be rendered.....

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APRV to the rescue

One out of ten critically ill patients in the intensive care unit (ICU) will develop acute respiratory distress syndrome (ARDS). In addition to low tidal volume ventilation, prone positioning and neuromuscular blockade, adjusting the mechanical ventilation mode may be another strategy to implement early in a patient’s clinical course when faced with ARDS complicated by refractory hypoxemia. 

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Critical Cases - Saddle Pulmonary Embolism!

A 68 year old male presents with ALS for near syncope at home. ALS reports they found the patient diaphoretic, complaining of generalized weakness and inability to stand which began acutely an hour ago. His blood pressure on scene was 60/palp, which improved to 100 systolic with a 500 ml IVF bolus. "Shock eh?" you think as you approach the room. "Better bring the ultrasound...."

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