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.
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I hope I never ever have to do this, but these people at the Essentials of EM conference make it look easy. I think this is worth watching. Some points I took away from the video: This is a resuscitative delivery. It is meant to save the mother. The fetus and uterus are diverting a…
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
Part One Part Two
Radiolab: End of Life Care
There was an amazing piece on the Radiolab podcast this week (Jan 15, 2013) on perceptions of end-of-life care. This is an issue that we face in the Emergency Department as we see many patients who present in their last minutes. This may be an acute exacerbation of a chronically ill person or an acutely…
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