Does contrast cause kidney injury? The evidence

A look at the evidence around post contrast acute kidney injury (or “contrast induced nephropathy”)

It’s time for another Emergency Medicine Cases Journal Jam, and we chose to tackle the concept of “contrast induced nephropathy” this time around. For this review, we focused on the risk of acute kidney injury following intravenous contrast for CT scans, because that is what we are really concerned about in the emergency department. For a variety of reasons, including higher contrast loads, higher risk patients, and procedure induced micro-emboli, the risk of kidney injury is significantly higher when using intra-arterial contrast for procedures such as cardiac catheterization. What follows are the notes I made in preparation for the podcast.

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Article of the month (November 2017)

There are a lot of recurrent themes in this month’s edition (which has clearly shifted from being a monthly to a bimonthly publication). Podcast over on BroomeDocs.

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Rapid Review: Acute Intermittent Porphyria

The Rapid Review series is designed to briefly review the key emergency medicine points from a single clinical review paper.

The topic: Acute Intermittent Porphyria

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Tend and Befriend: Sex, gender, and performance under pressure

Anyone who has taken the time to make it through my entire post on performance under pressure knows that I have spent a lot of time reading and thinking about stress and the ways it affects us in emergency medicine. I read hundreds of articles and books when preparing my lecture and post on the topic, which is why I was particularly surprised when I was asked to comment on the literature discussing gender differences in the stress response. Despite all my reading, I hadn’t come across a single paper on the topic. Continue reading “Tend and Befriend: Sex, gender, and performance under pressure”

Emergency Airway Management Part 2: Is the patient ready for intubation?

An approach to managing important pre-intubation physiology

Case

A 55 year old man was found unconscious in the bathroom by his family. He has a GCS of 7. His vital signs on arrival are a heart rate of 130, a blood pressure of 90/55, a respiratory rate of 28, and an oxygen saturation of 89% on room air. Although he was originally making sonorous noises, after elevating the head of the bed to 30 degrees, inserting a nasopharyngeal airway, and applying a jaw thrust, he is breathing quietly at 23 breaths a minutes, and his oxygen saturation has climbed to 92% with facemask oxygen…

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Emergency Airway Management Part 1: Optimizing the basics

An approach to the initial airway management of emergency department patients

Case

A 55 year old man was found unconscious in the bathroom by his family. He has a GCS of 7. His vital signs are a heart rate of 130, a blood pressure of 90/55, a respiratory rate of 28, and an oxygen saturation of 89% on room air. He is lying flat on the resuscitation stretcher and making some sonorous breath sounds. You resident grabs a laryngoscope and says, “ABCs… let’s get this guy intubated”…

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Articles of the month (September 2017)

Back with another edition of the “articles of the every month or so”. I love reading these papers and sharing them with everyone, but I’ve decided I should have at least a modicum of a pathetic social life as well, so every 2 months is probably the best I can do. Even then, I’m not sure they are worth what you are paying for them….

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