Massive Hemoptysis

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

Case

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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Procedure: Umbilical Vein Catheterization

A review of umbilical vein catheterization

Case

You find yourself leading a code pink in L&D, with no pediatricians to be found. You have already moved efficiently through the neonatal resuscitation algorithm, but despite clearing the airway, bagging, and chest compressions, the baby is still flat with a HR of 50. It is time for medications, but your experienced neonatal nurses have not been able to get a line. They look at you expectantly: “umbilical line, doc?”…

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Neonatal (Newborn) Resuscitation

Case

Code pink in labour and delivery, and you are the only doctor in the hospital tonight…

 There is a newer version of this post available, based on the updated 2015 ILCOR/AHA/ERC NRP guidelines. Please click here to see the most recent version.  Continue reading “Neonatal (Newborn) Resuscitation”

The Simplified Approach to PEA (non-traumatic)

A simplified approach to the initial assessment and management of emergency department patients in PEA

Case

A 60 year old woman is brought into your resus room VSA with CPR in progress. The paramedics tell you that she had a witnessed arrest and bystander CPR was performed for 4 minutes before they arrived on scene. They found her in PEA, took over CPR, started an IV, and rapidly transported as they were only 5 minutes out…


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The Difficult Delivery: Umbilical Cord Prolapse

A simplified approach to the initial assessment and management of emergency department patients with umbilical cord prolapse

Case

Once again, a 34 year old G5P4 woman at 39 weeks gestation is wheeled into your resus room in what appears to be precipitous delivery. You perform a quick exam, but instead of encountering the presenting part, you feel a pulsatile cord. Oh no, you remember hearing about umbilical cord prolapse back in medical school…

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The Difficult Delivery: Breech Presentation

A simplified approach to the breech delivery in the emergency department

Case

A 34 year old woman G5P4 at 39 weeks gestation is wheeled into your department, and your nurses tell you to get ready: she is crowning! You examine the patient, and sure enough she appears to be crowning, but something looks funny. That is a weird looking head. Oh wait, its a bum!

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The Difficult Delivery: Shoulder Dystocia

A simplified approach to the shoulder dystocia in the emergency department

Case

You are proceeding with the precipitous delivery described in the previous post. You have just delivered the head, but it seems to pull back. No further progress is being made. As you stare down at the head, you swear it reminds you of some kind of animal – oh right, a turtle! This is shoulder dystocia…

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