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


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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Palliative resuscitation: Managing dyspnea in emergency department palliative patients

A brief guide to the management of dyspnea in palliative patients in the emergency department


An 87 year old woman with metastatic breast cancer and severe COPD is brought by her daughter to the emergency department because of progressively worsening shortness of breath that they have been unable to manage at home. Her family has noticed a significant decline over the last month, such that she now rarely gets out of bed. She is followed by the local palliative care team and has completed paperwork to indicate that she should not want aggressive life prolonging therapy. The daughter was very anxious about coming to the emergency department, because her mother had been intubated in the past had made it clear that she would never want that again. Unfortunately, despite following the plans of her palliative physician, they were unable to control her severe dyspnea at home… Continue reading “Palliative resuscitation: Managing dyspnea in emergency department palliative patients”

Post-intubation deterioration in asthma

When the intubated asthma patient crashes: A Brief guide to the first 10 minutes of resuscitation


The 16 year old female with severe asthma you resuscitated last week ended up getting intubated. After calling the pediatric ICU you headed back into an overcrowded sea of belly pains and sprained ankles. 30 minutes later you are called overhead because the patient is now severely hypotensive and hypoxic…

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Management of life threatening asthma in the emergency department

An approach to the initial management of the asthma patient presenting to the emergency department in extremis


A 16 year old female with a history of severe asthma is brought to your community emergency department after a week of respiratory symptoms that have suddenly become much worse. She has been admitted to hospital 4 times this year, including one visit to the ICU. Her respiratory rate is 45 and she is using every accessory muscle she has, but she doesn’t appear to be moving much air. In fact, her lungs are silent to auscultation. She looks tired and the monitor shows her vitals as a heart rate of 140, blood pressure of 99/60, and an oxygen saturation of 88%…

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Massive Hemoptysis

A simplified approach to the initial assessment and management of emergency department patients with massive hemoptysis


The charge nurse grabs your arm and pulls you into the resuscitation bay, where EMS have just unloaded a 45 year old guy in obvious distress, coughing up a significant amount of blood. The paramedic tells you, “He doesn’t speak English, so we don’t know a lot about him. My guess is that he has already coughed up about 250ml of blood on route. He still sating OK, and his pressure is holding, but I’m just glad we got here. He’s all yours doc…”

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