End-tidal CO2 (EtCO2) monitoring is a measure of metabolism, perfusion, and ventilation. In the ED, we typically think of a EtCO2 as a marker of perfusion and ventilation. However, EtCO2 is an extremely powerful surrogate for endotracheal tube (ETT) Position, CPR Quality, Return of spontaneous circulation (ROSC), Strategies for treatment, and Termination (of CPR). Do these letters look familiar? They should! In this post we take a deep dive into each of these potential uses of EtCO2 in the ED.(more…)
Acute respiratory distress syndrome (ARDS) is a complex, life-threatening form of respiratory failure. It is responsible for almost 75,000 annual deaths in the United States.1Management remains lung-protective mechanical ventilation, an intervention that can begin in the ED. The Berlin Definition of ARDS has better predictive validity for mortality in comparison to previous definitions of ARDS.2 ALiEM Cards: ARDS, written by Dr. Michelle Lin, reviews the Berlin Definition and provides EPs with an on-shift resource to help manage critically-ill patients.
The role of extracorporeal membrane oxygenation (ECMO) in the management of acute respiratory distress syndrome (ARDS) has been a source of debate within the critical care community.1 The use of ECMO has steadily increased over the past decade;2 however, evidence to support the widespread adoption of this expensive and invasive technology is limited. As advances in ECMO technology have rapidly outpaced evidence, clinicians have been left to speculate as to ECMO’s true value. Is ECMO a promising tool to advance the care of patients with respiratory failure3 or an expensive distraction that has inappropriately supplanted evidence-based strategies?4
All who care for patients with ARDS have been eagerly awaiting the results of the Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome (EOLIA) trial which were recently published in May 2018’s New England Journal of Medicine.5
Computed tomography (CT) is increasingly available across U.S. Emergency Departments and has changed the practice of medicine. However, it is coupled with potential side-effects from radiation and contrast media. Emergency Medicine is beginning to make a concerted effort to identify clinical scenarios in which CT may be unnecessary, producing outcomes research and validated clinical decision rules. Renal colic and pulmonary embolism, in particular, seem amenable to this area of investigation. The ACEP E-QUAL Network podcast, a partnership with ALiEM to promote clinical practice improvements, reviewed this topic with experts Dr. Chris Moore (Emory University) and Dr. Jeffrey Kline (Indiana University). We present highlights from their discussion with Dr. Jason Woods.
Patients presenting to the ED with respiratory distress and a tracheostomy can unnerve almost any provider, and management is often fraught with preventable errors.1,2 This recognition has led to the development of treatment algorithms from groups including the U.K. National Tracheostomy Safety Project to improve the safety and quality of care for patients with tracheostomies.3 Use the ABC-Ts mnemonic to help you perform a focused tracheostomy evaluation and troubleshoot in a stepwise, systematic manner while waiting for your ENT consultant to arrive.
We are proud to present CAPSULES Module 9: Hospital Acquired Pneumonia (HAP), now published on ALiEMU. Here is a summary of the key points from a stellar module by Drs. Jamie Rosini and Matt Stanton. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.
Pediatric community-acquired pneumonia (CAP) is an acute, common, and potentially serious infection of the pulmonary parenchyma in children. In November 2010, the American Academy of Pediatrics endorsed “The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.” [PDF]1Based on this guideline, the American Academy of Pediatrics (AAP) Section on Emergency Medicine’s Committee on Quality Transformation developed a clinical algorithm for CAP in the ED setting.