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”…

Continue reading “Emergency Airway Management Part 1: Optimizing the basics”

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….

Continue reading “Articles of the month (September 2017)”

Would you choose adenosine?

Comparing adenosine to calcium channel blockers in the management of SVT

Hi sir. My name is Dr. Morgenstern. That racing feeling in your chest… it’s something we call SVT. That just means that you heart is going too fast. I’m going to get it slowed down for you. All that silly stuff we just did – getting you to blow in a syringe and raising your legs above your head – that sometimes works, but honestly, I have never seen it work myself. It’s time to stop asking you to “bear down” and move on to using medications to slow your heart down. Right now, your blood pressure is fine and you have no other problems, so we have a few options.

Option number one is a medication that works about 90% of the time, but it causes a horrible feeling when it is given. Some people describe it as chest pain. Others say is feels like they are going to die. Most people tell me it is the worst thing they have ever experienced.

Option number two is a medication that works closer to 100% of the time and doesn’t cause any pain at all.

Which would you prefer?

Continue reading “Would you choose adenosine?”

Articles of the month (July 2017)

Welcome back to another edition of the articles of the month. I am considering changing the format of my article reviews going forward. Because multiple articles are grouped together in a single post, I frequently have a hard time finding articles I have reviewed when I am looking for them. I might start posting each article as its own blog post, with 8-10 posts over the course of a month. I’d love to hear what people think of that idea – whether it would be better or worse for your reading habits. Either way, Casey and I will still discuss the best articles each month on the Broome Docs podcast. Continue reading “Articles of the month (July 2017)”

EM Mindset: Not knowing

This post was written for the fantastic EMDocs.net EM Mindset series.  If you have not come across this series before, I strongly recommend checking it out. You can find it here. Thanks to Alex Koyfman and Brit Long for their edits. Continue reading “EM Mindset: Not knowing”

Embedding decision tools into the electronic record

Last week I picked up a chart at work. It was a 25 year old woman who had sneezed very hard and developed some right sided rib pain. She had waited about 2 hours to see me after being sent in from a walk in clinic with a note asking me to “rule out PE” because the pain was, unsurprisingly, pleuritic. She had normal vital signs. She had an x ray done at the walk in clinic that ruled out pneumothorax. She had no history of or risk factors for VTE. She had a Well’s score of 0. She was PERC negative. Continue reading “Embedding decision tools into the electronic record”

Interventional therapy for acute ischemic stroke: the evidence

A summary of the evidence for endovascular therapy in stroke

In part 2 of our EM Cases Journal Jam, we explored the literature looking at endovascular therapy for acute ischemic stroke. (Part 1 on the evidence for thrombolytics can be found here.) The studies of interventional therapy for stroke tend to get broken down into the early (negative) studies and the later (positive) studies. For consistency, I’ll use the same break down. Continue reading “Interventional therapy for acute ischemic stroke: the evidence”