Carbon monoxide (CO) is an odorless, colorless gas and is one of the most common causes of unintentional poisoning deaths in the United States. It is also one of the most common poisoning presentations to Emergency Departments. Because CO is produced by the incomplete combustion of carbon-containing fuels, the incidence of accidental exposure peaks during the winter months due to increased use of in-door heating sources and reduced ventilation. 1–3 Several management dilemmas commonly arise when dealing with patients with potential CO poisoning.
The first time I saw the Thumper performing CPR on a patient I thought “well, that makes sense.” Since then we have seen other devices, most notably the Zoll AutoPulse and the Physio-Control LUCAS. It was disappointing to many in 2005 when the AutoPulse trial was halted early due to harm. 1 Although four-hour survival was similar between groups, the hospital discharge survival rate in the manual CPR group was 9.9% compared to 5.8% in the mechanical CPR group. Many hypotheses were proposed to explain the results, which included Hawthorne effect, prolonged device deployment time, and enrollment bias. Last month, the results of the LUCAS in Cardiac Arrest (LINC) trial were published in JAMA, breathing new life into the mechanical vs manual CPR debate. 2
Intravenous sodium bicarbonate seems like a wonderful drug. It fixes acidosis, pushes potassium into cells, alkalinizes urine, and even helps with smelly feet. However, this literature review of four conditions casts some doubt into the seemingly cure-all that is bicarbonate.
Emergent airway management and severe sepsis are both high-risk situations that are commonly encountered by emergency physicians. It is well known that complications can be high in both situations, which in turn can lead to increased morbidity and mortality. For instance, about 1/4 of patients who are hemodynamically stable prior to intubation get post-intubation hypotension (PIH) after rapid sequence intubation. Also septic patients may not be reliably identified by systemic inflammatory response syndrome (SIRS) markers early in their disease course. The Shock Index (SI) may be an adjunct that is easy to calculate and could predict both PIH and severe sepsis.
The authors use distinct methods for tallying computed tomography (CT) use in the 2 countries. List the biases that could occur in counting CTs by each method.
We sometimes hear information stated as fact that may not be entirely accurate. One such example is, “I’m going to use lorazepam because it isn’t metabolized by the liver.”
Let’s set the record straight.
ALL benzodiazepines are metabolized by the liver.
You have a 54-year-old female who presents to the emergency department with a chief complaint of “just feeling out of it.” She has felt “off and on” for the past 12 hours and has had an occasional cough with some sputum production along with “the shakes and chills.” She also feels as if her heart was “going at a mile a minute” and because of this, she is very much out of breath.