Author: Joshua Ruff, MD – PGY2 Go ahead, scan them head to toe. Background The CT scanner: aka ‘donut of truth’ aka ‘answer box’ The stigma of over-scanning is real We are taught to be thoughtful and judicious with diagnostics CT scans are expensive, resource heavy Risks: contrast nephropathy, radiation exposure, etc. The EM physician:…
Author: Dr. Tisma Background/Study Question How often do septic patients receive their second antibiotic dose later than they should? What are the risk factors for these delays? And do these delays affect patient outcomes? Leisman et. al. published a study in 2017 that examined these important inquiries. These questions are particularly interesting to me as…
Author: Vanessa I. Petrak, M.D. Background: Septic Shock is a dysregulated host response to infection, resulting in life-threatening circulatory, cellular, and metabolic abnormalities. Sepsis is associated with a dysregulated response of the hypothalamic-pituitary-adrenal axis that may involve any of the steps from cortisol production to cortisol use by cells. Short term mortality is approximately 45-50%, and…
Author: Dr. Collin Wulff, DO Study Question: Does early low-dose norepinephrine improve shock control in those with sepsis with hypotension? Design: Mostly good buzzwords here; single center, randomized, double-blind, placebo controlled clinical trial, smallish study (310 total). The study group received a fairly low dose of norepi infusion (0.05 mcg/kg/min). The primary outcome was not…
Author: Dr. Catherine Buckley
It’s catchy. It rhymes for love’s sake! But is it necessary?
Central venous access is an important procedure for critically ill patients. One consideration when placing a venous catheter is the risk of catheter-related bloodstream infections (CRBIs), which can be a significant cause of morbidity and mortality in hospitalized patients. In 2012, there were 15 million central venous catheter (CVC) days per year in the US in ICUs, and the rate of infections per catheter days is 3/1000. This post looks at a systematic review done by Marik et. al. that examines CRBIs among internal jugular, subclavian, and femoral central venous sites.
…
Here are some great videos on how to use bougies. Intubation with bougies Scott Weingart… yes, yes, but his video is good. Shows a preloaded bougie, which is what we should probably be doing. Has some great trouble shooting techniques Bougie cric Darren Braude’s video. A different view of the whole thing. I like this…
Ruben Strayer of EMUpdates posted a great video on how to do a cricothyrotomy. The only things that I would change are I would likely be swearing a lot more out of sheer panic I’d have everything ready (syringe and bougie) I’d pass the bougie in before removing the scalpel, just paranoid of losing that entrance…
Kleinman et al, “Part 14: Pediatric Advanced Resuscitation.” Circulation. November 2, 2010. (Supplement). It’s available free online, go grab a copy and enjoy with a nice cup of coffee. Introduction Airway Monitoring and Access Drugs (part 1) Drugs (part 2) Pulseless Arrest Bradycardias Tachycardias
