A brief critical appraisal of the IRIS trial (Birenbaum 2018)
Despite being described by Sellick almost 60 years ago, there has never been any convincing evidence supporting cricoid pressure during rapid sequence intubation. (Sellick 1961) Based on physiologic reasoning, it is frequently described as being “standard of care”. However, when studied, cricoid pressure doesn’t actually seem to decrease aspiration. (Ellis 2007; Neilipovitz 2007; Fenton 2009). Worse, cricoid pressure has been shown to worsen laryngeal view during intubation, and even completely obstruct the airway. (Allman 1995; Palmer 2000; Levitan 2006; Oh 2013) The result has been a relatively classic debate in medicine between a historical “standard” and science. Unfortunately, the available science has been relatively weak, until now…
Continue reading “Cricoid pressure is dead (Birenbaum 2018)”
A guide to the resuscitation of myasthenic crisis in the emergency department.
A 50 year old woman presents with a 2 day history of dysuria, for which she was started on ciprofloxacin last night. Since this morning, she has become increasingly weak, and now finds it impossible to get out of bed. She called 911 when she noticed she couldn’t catch her breath. She wonders whether this might be related to her myasthenia gravis…
Continue reading “Myasthenic crisis”
A rapid review of the diagnosis and management of myasthenia gravis in the emergency department.
In the Rapid Review series, I briefly review the key points of a clinical review paper.
The topic: Myasthenia gravis
The paper: Spillane J, Higham E, Kullmann DM. Myasthenia gravis. BMJ (Clinical research ed.). 2012; 345:e8497. PMID: 23261848
Continue reading “Rapid Review: Myasthenia Gravis”
So far this week, I have covered 2 large trials looking at airway management strategies in out of hospital cardiac arrest. In both instances, outcomes were similar whatever strategy was employed. Maybe our choice of airway management doesn’t matter? Not so fast, we finish the series with a final RCT, and this time there is a winner. Continue reading “Airway management in cardiac arrest part 3: PART trial (Wang 2018)”
Airway management is cardiac arrest is always a hot topic of debate. Yesterday we looked at AIRWAYS2, demonstrating no difference in survival with good neurologic outcomes between a laryngeal mask airway and intubation. (Benger 2018) However, those are both advanced interventions. Are either required? Where does the mighty bag valve mask fit in? Today we tackle the second paper in our series of 3, comparing BVM to intubation in out of hospital cardiac arrest.
Continue reading “Airway management in cardiac arrest part 2 (Jabre 2018)”
Critical appraisal of the AIRWAYS2 trial (Benger 2018)
You probably don’t need a medical degree to know that breathing is important, and that in order to breathe, you need to have an unobstructed airway that connects your lungs to the world. As a result, when you die, one of our first instincts in medicine is to ensure that you have an open airway. However, if your heart is stopped, fiddling around with the airway will do nothing to restart it. Furthermore, it has never been clear whether advanced airway interventions like intubation are any better than simply maneuvers like a jaw thrust in the context of cardiac arrest. Although emergency physicians love intubating, observational data has suggested that advanced airway management might not be a priority in cardiac arrest. (Hasegawa 2013; Benoit 2015) This week we will cover 3 large RCTs addressing the issue. This is part 1.
Continue reading “Airway management in cardiac arrest part 1: AIRWAYS 2 (Benger 2018)”
My journey through science and feminism
I attended the incredible FIX18 conference in New York earlier this year. One thing really stood out to me: the refrain “why are you here?” (or “why did you go to that?”) Continue reading “I am a skeptic because I am a feminist”