Trick of the Trade: Pre-Charge the Defibrillator

In cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome.¹ There has also been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why? Because we know interruptions are bad.^2,3 One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival.^4,5 Can we do better to shock sooner and minimize these pauses?

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By Sam Ghali, MD|2016-12-16T16:05:59-08:00May 16, 2016|CME, Critical Care/ Resus, Expert Peer Reviewed (Clinical), Tricks of the Trade|

Synthetic cannabinoid use reaches new heights: K2 is not just a mountain on the China-Pakistan boarder

You are working a shift in the emergency department, and you hear the ambulance sirens. EMS is bringing you two patients, friends from a nearby shelter. Per report, the two men were “smoking drugs” together outside of the shelter. Bystanders noted that the 29-year-old man became increasingly agitated, shouting, banging on the door, and threatening his other shelter mates, while the other, a 50-year-old man, laid down on the sidewalk. EMS also reports picking up these patients in an area known for high “K2” use.

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By Denise Fernandez, MD|2017-03-05T14:18:46-08:00Apr 27, 2016|CME, Tox & Medications|

Radiation risk in children getting CT imaging

The Case: A 5 year old girl presents to the ED with approximately 24 hours of suprapubic and RLQ abdominal pain. Vital signs are: Temp 38.2 C, HR 110, RR 19, BP 100/60, Oxygen Sat 100% on room air. She has vomited twice but has not had diarrhea. She had a history of constipation a year ago that has resolved and mother denies any urinary symptoms or history of UTI’s. The patient is quiet but nontoxic appearing. Your abdominal exam notes mild to moderate RLQ tenderness but no rebound and normal bowel sounds. You order a urinalysis, which is negative and a RLQ US which ‘does not visualize the appendix’. Your suspicion for possible appendicitis is still intermediate; however, now the patient states she is “a little hungry”. Should you order a CT of the abdomen and pelvis? Uuugh!

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By Robert Cloutier, MD MCR|2019-11-12T19:18:02-08:00Jan 25, 2016|CME, Pediatrics, PEM Pearls, Radiology|

PEM Pearls: Cardiac causes of pediatric chest pain

Children with chest pain commonly present to the emergency department. Both the child and family members may think their symptoms are due to a serious illness. Among adolescents seen for their chest pain, more than 50% thought they were having a heart attack or that they had cancer.¹ In reality, only 6% of pediatric chest pain has a cardiac etiology.² Nonetheless, extensive and costly emergency department (ED) evaluations are common and there is wide practice variation.³

But prior to reassuring your patient, what can you do to reassure yourself that your patient doesn’t need a more extensive workup? What would make you suspicious for cardiac causes of pediatric chest pain?

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By Delphine Huang, MD|2017-10-26T14:34:30-07:00Dec 14, 2015|Cardiovascular, CME, Pediatrics, PEM Pearls|

Highlights from the 2015 American Heart Association CPR and ECC guidelines

The 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).