Airway management in cardiac arrest part 3: PART trial (Wang 2018)

So far this week, I have covered 2 large trials looking at airway management strategies in out of hospital cardiac arrest. In both instances, outcomes were similar whatever strategy was employed. Maybe our choice of airway management doesn’t matter? Not so fast, we finish the series with a final RCT, and this time there is a winner. Continue reading “Airway management in cardiac arrest part 3: PART trial (Wang 2018)”

Airway management in cardiac arrest part 2 (Jabre 2018)

Airway management is cardiac arrest is always a hot topic of debate. Yesterday we looked at AIRWAYS2, demonstrating no difference in survival with good neurologic outcomes between a laryngeal mask airway and intubation. (Benger 2018) However, those are both advanced interventions. Are either required? Where does the mighty bag valve mask fit in? Today we tackle the second paper in our series of 3, comparing BVM to intubation in out of hospital cardiac arrest.

Continue reading “Airway management in cardiac arrest part 2 (Jabre 2018)”

Airway management in cardiac arrest part 1: AIRWAYS 2 (Benger 2018)

Critical appraisal of the AIRWAYS2 trial (Benger 2018)

You probably don’t need a medical degree to know that breathing is important, and that in order to breathe, you need to have an unobstructed airway that connects your lungs to the world. As a result, when you die, one of our first instincts in medicine is to ensure that you have an open airway. However, if your heart is stopped, fiddling around with the airway will do nothing to restart it. Furthermore, it has never been clear whether advanced airway interventions like intubation are any better than simply maneuvers like a jaw thrust in the context of cardiac arrest. Although emergency physicians love intubating, observational data has suggested that advanced airway management might not be a priority in cardiac arrest. (Hasegawa 2013; Benoit 2015) This week we will cover 3 large RCTs addressing the issue. This is part 1.

Continue reading “Airway management in cardiac arrest part 1: AIRWAYS 2 (Benger 2018)”

Respiratory distress in the patient with a tracheostomy (update)

A summary of the emergency medicine approach to respiratory distress in the patient with a tracheostomy

This is an update of a previous version of this post. I am reposting to coincide with the release of a new textbook that I am pretty excited about. The textbook is the Resuscitation Crisis Manual. It provides very succinct action scripts for the major emergencies that we see. It is exactly the textbook that I always wanted in residency, but didn’t exist. The absence of this kind of resource was exactly the reason that I started First10EM. (Perhaps, in the future, Scott can just keep me up to date on his projects. If I had just waited a couple years, I could have had the textbook without feeling like I had to write it by myself.) I wrote the “Tracheostomy Emergencies” chapter of the book – hence the decision to repost this topic. (I guess I should note that I don’t get anything for writing that chapter, so I don’t have any financial conflicts of interest – just intellectual biases.)

If you want to hear more about the book, check out this EMCrit podcast.

Case

A 45 year old man, well known to your department because of a prior anoxic brain injury and multiple complications including a permanent tracheostomy, is brought in by ambulance from home in respiratory distress. You know from prior conversations with the family that the patient is to receive full, aggressive medical management. He is using every accessory muscle that you can see, his respiratory rate is 55, and his oxygen saturation is 87% on room air…

Continue reading “Respiratory distress in the patient with a tracheostomy (update)”

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)”

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)”

Post-intubation deterioration in asthma

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

Case

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…

Continue reading “Post-intubation deterioration in asthma”