Highlights from the 2015 American Heart Association CPR and ECC guidelines

AHA guidelinesThe newest round of the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) contains 315 recommendations.1 It is easy to be overwhelmed by this massive (275 pages) document so this post will distill what you need to know in the emergency department. This update marks the end of a 5-year revision cycle for the AHA and the shift to a continuously updated model. Current and future guidelines can now be found at ECCGuidelines.heart.org. This round lacks any of the major foundational changes seen in 2010; however, we do say goodbye to some recommendations (bye bye vasopressin).

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PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

capnographyFor many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end tidal capnography, providers have access to so much more information during a cardiac arrest resuscitation, as summarized by the recently released 2015 American Heart Association (AHA) recommendations.1 Thanks to Dr. Abdullah Bakhsh from Emory University for a great PV card to help remind us of these key cardiac resuscitation pearls.

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AIR Series: Cardiology – CHF, PVD, and Others (part 2)

As mentioned last module, the FOAMsphere contains a phenomenal amount of cardiology content. Accordingly, the CORD testing schedule and our cardiology module has been divided into two parts. Below we have listed our selection of the 12 highest quality blog posts within the past 12 months (as of August 2015) related to acute coronary syndromes, curated and approved for residency training by the AIR Series Board. In this module we have 6 AIRs and 6 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media Index.

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AIR-Pro Series: Cardiovascular (2015)

Below we have listed our selection of the 8 highest quality blog posts related to 3 advanced level questions on cardiovascular topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:

  1. Advanced concepts about Sgarbossa’s Criteria
  2. Troubleshooting pacemaker’s and automated implantable cardioverter defibrillators (AICD’s)
  3. Troubleshooting left ventricular assist devices (LVAD’s)

In this module, we have 5 AIR-Pro’s and 3 Honorable Mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.

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60-Second Soapbox: Abernethy (Pain Medications), Bellew (Posttest Probability), Bouthillet (Wide Complex Tachycardia)

aliem_soapboxWelcome to the second bolus of 60-Second Soapbox! Each episode, one lucky individual gets exactly 1 whole minute to present their rant-of-choice to the world. Any topic is on the table – clinical, academic, economic, or whatever else may interest an EM-centric audience. We carefully remix your audio to add an extra splash of drama and excitement. Even more exciting, participants get to challenge 3 of their peers to stand on a soapbox of their own!

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AIR Series: Cardiology Module, Part 1 (2015)

There is a phenomenal amount of cardiology content in the FOAMsphere. Accordingly, the CORD testing schedule and our cardiology module has been divided into two parts – Part 1 (ACS) and Part 2 (CHF, Vascular Dissection, and Other). Below we have listed our selection of the 14 highest quality blog posts within the past 12 months (as of July 2015) related to acute coronary syndromes, curated and approved for residency training by the AIR Series Board. In this module we have 6 AIRs and 8 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media Index.

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Trick of the Trade: Squeeze test for confirmation of IO placement

IO needlesVenipuncture is the most common invasive procedure performed in the emergency department 1 , likely due to the fact that the vast majority of our laboratory evaluations require blood and many of our life saving interventions require access to the patient’s systemic circulation. Most of the time emergency department staff are able to perform this procedure easily, but occasionally you find that your patient is the dreaded “difficult stick”. Literature suggests that the landmark technique is successful on the initial venipuncture 74-77% of the time. 2–5  Success rates rise after multiple attempts, but what happens when you don’t have the luxury of time? What happens when your patient will die if you don’t get life saving medications into their circulation promptly?  There are a few options when you can’t get IV access through traditional means, among them external jugular vein cannulation, central line, ultrasound-guided IV, and the intraosseous lines (IO).6 However, when managing the crashing patient, a wise decision is to use the quickest option, which is often the IO.

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