Prehospital: Does QUICKER hypothermia equal BETTER hypothermia?
The short answer to this question is NO. Since the landmark post-arrest, therapeutic hypothermia studies published in 2002, 1,2 extensive efforts have been made to ensure our post-arrest patients are cooled… and cooled fast. It only seemed logical to extend this revolutionary treatment into the field and have paramedics begin the cooling in the field. New EMS protocols were developed around the country to incorporate hypothermia into cardiac arrest management and well received by paramedics and EMTs. But a recent JAMA publication calls this now into question. 3 [+]
Bicarbonate: Completely Useless?
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. [+]
Modified Sgarbossa Criteria: Ready for Primetime?
The recognition of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult and frustrating to both emergency medicine physicians and cardiologists. According to the 2004 STEMI guidelines, emergent reperfusion therapy was recommended to patients with suspected ischemia and new LBBB however, the new 2013 STEMI guidelines made a drastic change by removing this recommendation. Several papers have recently been published discussing a modified Sgarbossa’s criteria and a new algorithm to help decrease false cath lab activation and/or fibrinolytic therapy, but are they ready for primetime? [+]
Elder Abuse and Neglect: What to do in the Emergency Department
Have you ever identified elder abuse in a patient in your ED? The signs can often be subtle, can look like one of many other medical or traumatic problems, and can be mistaken for aging-related changes. This is an unpleasant topic, but rather than bury our heads in the sand and pretend it doesn’t happen, let’s face it and see what we can do to intervene and help. How can you miss it less often? And what are your legal obligations if you suspect elder abuse? [+]
MEdIC Series: The Case of the New Job Negotiations – Expert and Community Response
The Case of the New Job Negotiations outlined a situation that every physician goes through. After 10-15 years of education in various forms, we finally need to find a “real” job. Things like “how to negotiate” and “what to look for in a job” are not part of the usual medical curriculum so Teresa Chan (@TChanMD) and I (@Brent_Thoma) thought it would be worth building a MEdIC cases that raises these issues. [+]
Just in Time Training
Just in Time Training (JiTT) is an educational concept that has been easily adapted for EM. Interesting, this educational strategy originates from inventory management. To them, JiTT means: right material, right time, right place, in the exact amount. In educational terms, this means: right educational modality, given to the learner at the right time, at the right location, and exactly the amount needed. [+]
Calling all EM residents: Submit an abstract to Annals of EM
Did you know that there is a section in the Annals of Emergency Medicine that is written by EM residents only? As Annals’ Resident Fellow, I wanted to share a great writing and publishing opportunity with my fellow residents. Many of the residents who have published in this series have gone on to do great things in EM as faculty members. [+]
Subsegmental Pulmonary Embolisms (SSPE) are Important
Multi-detector computed tomographic pulmonary angiography (CTPA) allows for better visualization of peripheral pulmonary arteries allowing for diagnosis of small peripheral emboli limited to the subsegmental pulmonary arteries. Interestingly as these SSPE’s get diagnosed more and more, two questions come to mind: What is the prognostic utility of diagnosing SSPEs? What is the morbidity and mortality of SSPEs compared to more proximal PEs? A recent study in 2013 Blood looked at these questions. 1 [+]
The Not-So-Sick Health-Care Associated Pneumonia Patient: New Treatment Strategy
Health-care associated pneumonia (HCAP) is the term used to describe patients presenting with pneumonia who may be at higher risk of multi-drug resistant (MDR) pathogens than other patients presenting from the community due to recent contact with the health care system. What are the criteria for HCAP? [+]
Shock Index: A Predictor of Morbidity and Mortality?
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. [+]