Peripheral vasopressors: the myth and the evidence

The evidence for using vasopressors through a peripheral IV

You are working in a small, rural hospital staffed by one physician and one nurse. There are multiple sick patients, all of whom require your attention, but the sickest is probably the 62 year old female with pneumonia and a blood pressure of 75/40 despite 3 liters of normal saline. This is septic shock, and you need to start a vasopressor, but the hospital protocol is that norepinephrine should only be given through a central line. You just haven’t had time to get one started, and wonder if it wouldn’t be better to get the patient started on the vasopressor using their peripheral IV.

The myth: It is an absolute contraindication to administer vasopressors through a peripheral intravenous line.

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Articles of the month (May 2018)

A monthly (ish) summary of the emergency medicine literature

Welcome to another edition of the (bi)monthly medical articles that caught my attention. As always, you can hear Casey and I ramble on about these articles and other quasi-related medical issues on the BroomDocs podcast. Continue reading “Articles of the month (May 2018)”

NPO for sedation? Don’t swallow the myth

A brief review of the evidence for fasting in sedation

When was your last meal? Yes, I know that your leg is currently bent at about a 90 degree angle, but I must know, when did you last eat? You had some chips an hour ago? Well I’m very sorry, but you are just going to have to wait. Next time, remember that you need an empty stomach if you are going to have an emergency… Continue reading “NPO for sedation? Don’t swallow the myth”

Petition to retire the surviving sepsis campaign guidelines

What follows is a post that you will see on a number of websites this week explaining the petition to retract the 2018 Surviving Sepsis Campaign guidelines. You can read the guideline here. Although many of the individual recommendations seems reasonable, I think these guidelines could end up harming patients. Continue reading “Petition to retire the surviving sepsis campaign guidelines”

Articles of the year (EMU 2018)

Hand out for the articles of the year lecture at EMU 2018

I love evidence based medicine, but I definitely understand the criticism that EBM nerds like myself can come across as very negative. Thrombolytics don’t work. BNP isn’t helpful. Stress testing is a sham. Idarucizumab? Yeah right. I think this scientific criticism is crucial, but I understand that it isn’t always fun. So when I was asked to present my favourite articles of the year at the North York General Emergency Medicine Update, I decided to stay entirely positive. I only chose papers that were potentially  practice changing, but more importantly, that could have a positive impact on clinical practice. These are the papers I chose.

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Resuscitation of pulmonary hypertension and right ventricular failure

A guide to the initial emergency department management of patients with pulmonary hypertension and right ventricular failure

Case

A 40 year old female presents by EMS with significant dyspnea. She has had a fever and cough for 2 days, and has been getting progressively more short of breath. Today, she almost fainted when she stood up, so she called 911. Her vital signs are HR 135, BP 88/45, RR 35, and an oxygen saturation of 90% on a nonrebreather. She is quite somnolent. As she is being transferred to the stretcher, the paramedic mentions that she has a pump of some sort to treat her pulmonary hypertension…

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Rapid Review: Dengue Fever

A rapid review of Dengue fever for emergency medicine clinicians

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

The Topic: Dengue Fever
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