RUSH protocol: Rapid Ultrasound for Shock and Hypotension
Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for the evaluation of critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states. The RUSH Protocol was first introduced in 2006 by Weingart SD et al, and later published in 2009. It was designed to be a rapid and easy to perform US protocol (<2 minutes) [...]
PV card: Pediatric Assessment Triangle
Have you heard of the Pediatric Assessment Triangle? Taught in the Pediatric Education for Prehospital Professionals (PEPP) certification course, it provides a clear and simple approach to the emergency assessment of pediatric patients. The following PV card summarizes the PAT: […]
Out-of-Hospital Cardiac Arrest and Prehospital Intubation
Worldwide, death from cardiac arrest in the out-of-hospital setting remains the leading cause of mortality. Focuses have aimed at improving bystander CPR, public access to AEDs, minimizing chest compression interruptions, and decreasing the emphasis on advanced airway management. This latter concept has become so important that the AHA/ASA have now changed their “ABC” philosophy to “CAB.” Below is the review of the literature that has changed this philosophy. […]
Patwari Academy video: Child abuse injury patterns
What are common injury patterns seen in children who are abused? Non-accidental trauma should always be considered in pediatric patients who present with traumatic injuries. Watch this great 8 minute video on child abuse injury patterns by Dr. Rahul Patwari. […]
On the Horizon: Propofol for Migraines
Propofol for the treatment of migraines in the ED might be on the horizon. This will possibly be a new practice in emergency medicine, although it has been known for some time. Propofol, when given at procedural sedation doses, seems to miraculously terminate migraines refractory to usual treatment. Patients awake with minimal to no headache and may be discharged from the ED much quicker than traditional treatment with possibly less side effects. The proposed mechanism of action is described in below papers, but in short, propofol seems to “reboot” the brain and terminate the migraine. […]
PV Card: Contraindications to Thrombolytics in Stroke
This Paucis Verbis (PV) card is an updated version of the PV card on Contraindications to Thrombolytics for CVA from September 10, 2010, based on the Stroke 2013 AHA/ASA new guidelines that were just published.1 Some changes include… […]
Calcium before Diltiazem may reduce hypotension in rapid atrial dysrhythmias
The Case A 56 y/o man presents to the ED via ambulance. He was sent from clinic for ‘new onset afib.’ His pulse ranges between 130 and 175 bpm, while his blood pressure is holding steady at 106/58 mm Hg. He has a past medical history significant for hypertension and hypercholesterolemia. His only medications are hydrochlorothiazide and atorvastatin. The decision is made to administer an IV medication to ‘rate control’ the patient with a goal heart rate < 100 bpm. Calcium channel blockers, such as diltiazem and verapamil, can both cause hypotension. In the case above, the patient has [...]
Patwari Academy video: Discharge instructions
Read more about the writing of appropriate ED discharge instructions. Clear communication of your thoughts and recommendations are a crucial part of patient care despite their no longer being in the ED. Learn about the pearls and pitfalls in writing instructions in this short 7.5 minute video. 1 […]
ALiEM Sim Case Series: Pediatric WPW
Case Writer: Nikita Joshi, MD Keywords Pediatrics, Syncope, Wolff Parkinson White (WPW), PALS Educational Objectives Medical Discuss a broad differential diagnosis for pediatric syncopeIdentify critical findings in pediatric EKGManage WPW tachycardia Communication Obtain a focused history in a pt with WPW focusing upon family historyCommunicate as an interdisciplinary team Case Synopsis 10 yo boy BIBEMS s/p syncope. Pt was playing on the football field, running down field when he suddenly collapsed. Bystanders quickly went to the boy and within 1 minute the pt had regained consciousness without any intervention. When EMS arrived on the scene, the boy was sitting with [...]
PV card: Early repolarization vs STEMI on EKG
You are handed an EKG for a 50 yo man with moderate chest pain for 2 hours now and no associated symptoms typical for ACS, PE, aortic dissection, or any other red flags of chest pain. He has no prior EKG’s on file. Is this early repolarization or ST elevation MI? Should I activate the cardiac catheterization lab? […]