Alarms from the ventilator: Troubleshooting high peak pressures

VentilatorAirway management is one of the defining skills of an emergency physician, but our role in the care of intubated patients may continue long after endotracheal tube placement is confirmed. In mechanically ventilated patients, acute elevations in airways pressures can be triggered by both benign and life-threatening causes. When the ventilator alarms, do you know how to tell the difference? What is your approach in troubleshooting the potential problems?

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Supraventricular Tachycardia (SVT) With Aberrancy Versus Ventricular Tachycardia (VT)

2011_04_22AwmEPRDifferentiating between SVT with aberrancy and VT can be very difficult. It is crucial to be able to make this distinction as therapeutic decisions are anchored to this differentiation. Brugada et al prospectively analyzed 384 patients with VT and 170 patients with SVT with aberrant conduction to see if it was possible to come up with a simple criteria to help differentiate between the two with high sensitivity and specificity.

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2019-09-10T13:36:56-08:00

EKG Subtlety: Tall T-Wave in Lead V1

Balance

EKGs are a simple, cheap modality that can give an emergency physician quite a bit of information.  Sometimes, in a busy ER, this information can be very subtle and almost overlooked without a second thought. A perfect example of this is a New Tall T-wave in  lead V1 (NTTV1). This finding can be a normal variant, but can also be a precursor to badness.

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2019-09-10T13:37:03-08:00

Trick of the Trade: Urine pregnancy test without urine

pregnancy_tests_in_bulkA 25 year old woman presents to the Emergency Department having syncopized in the waiting room, where she was triaged with the chief complaint of abdominal pain. Ectopic pregnancy immediately bubbles to the top of your differential diagnosis. The patient is too dizzy to walk to the bathroom to give you a urine specimen to check a urine pregnancy test. Plus, she admits that she just urinated in the waiting room bathroom a few minutes ago – so no urine now.

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