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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Most medical practices are not parachutes

I was invited on EMCrit to discuss my position on idarucizumab and I fear I didn’t do a great job explaining myself. I don’t want to spend more time discussing the specifics of idarucizumab, but I think the larger problem of declaring that a therapy works without study, or declaring that it would be unethical to study a therapy because we “know it works” despite a lack of randomized control trials, is worth pursuing. Continue reading “Most medical practices are not parachutes”

Magical thinking in modern medicine: IV antibiotics for cellulitis

A summary of the evidence comparing IV to oral antibiotics for cellulitis

“I’ve been on these oral antibiotics for 36 hours and my cellulitis isn’t improving. My doctor sent me in because I NEED IV antibiotics.”

“This patient has pretty mild cellulitis, but he does have a fever, so I think we should go with IV antibiotics.”

“That is a pretty big cellulitis. There is no way it is going to improve with just oral antibiotics.”

Among physicians and patients alike, it is generally accepted that IV antibiotics are better than oral. They are stronger. They will work faster. They will save the day when oral antibiotics have failed. But do the bacteria floating around in the soft tissues of your leg really care (or even know) whether the antibiotics entered your system through a vein or via the stomach?

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Articles of the month (March 2018)

A monthly (ish) summary of the emergency medicine literature

Every two months or so I write a monthly summary of the most interesting medical literature that I have encountered. This is one of those summaries. Continue reading “Articles of the month (March 2018)”

BNP in the emergency department: The evidence

A review of the BNP literature

In the most recent episode of Emergency Medicine Cases Journal Jam, Rory, Anton, and I cover the evidence for (for against) using BNP in the emergency department. These are my notes.  Continue reading “BNP in the emergency department: The evidence”

Guidelines on intubation in critically ill patients

Some key take home points from a new guidelines on airway management in critically ill patients

Just as I set the last blog post in the airway series to post, a fantastic guideline was published on intubation in critically ill adult patients. It covers most of the content I tried to cover in those posts, and probably does a much better job. I recommend that everyone take the time to read it. I have already covered a lot of this information in the airway series, but as a way of reinforcing the lessons from those posts, I thought I would go through my personal takeaways from this document.

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