Managing unstable bradycardia

A brief overview of the initial management of unstable bradycardia in the emergency department

Case

A 67 year old man is brought in by EMS after a syncopal episode at home. He has only partially regained consciousness, with a GCS of 12. His wife says that he has had a fast heart rate before and that he also has diabetes and high blood pressure. She isn’t sure what medications he is on. He has had flu like symptoms for a few days. The paramedic vital signs were a heart rate of 38, a blood pressure of 69/45, a respiratory rate of 22. The oxygen saturation tracing has been inconsistent, but they think it is probably about 91% on room air… Continue reading “Managing unstable bradycardia”

Articles of the Month (August 2016)

The best emergency medicine articles that I came across in August 2016

Welcome to another edition of my favorite emergency medicine articles of the month. Once again, there will be an accompanying podcast with the talented and insightful Dr. Casey Parker on the BroomeDocs website where we briefly discuss these articles. Continue reading “Articles of the Month (August 2016)”

Articles of the month (July 2016)

Another month and another edition of the articles of the month. However, this time I have some very exciting news. I have teamed up with Casey Parker (the brilliant, smooth-talking Australian physician, not the adult film star) to produce an audio version of these summaries. You will be able to find this podcast on http://broomedocs.com/, a great FOAM website that everyone should probably be following anyway. This is the first edition, and we will likely tweak the format with time, so if you have any feedback (hopefully more constructive than, “Justin, you have the perfect voice for silent films”), we would love for you to get in touch. Continue reading “Articles of the month (July 2016)”

Management of the Massive GI Bleed

A brief summary of the initial emergency department resuscitation of a patient with massive gastrointestinal bleeding

Case

You are called urgently to resuscitation. Walking into the room, you recognize a familiar face. In fact, didn’t you discharge him home yesterday with epigastric pain that you attributed to his chronic alcohol use? Today’s diagnosis is not a mystery. There is already a puddle of blood on the floor, and he is quickly filling another emesis basin with bright red blood. A glance at the monitor reveals a heart rate of 135 and a blood pressure of 74/34…

Continue reading “Management of the Massive GI Bleed”

Balloon tamponade of massive GI bleeding

A brief summary of the procedure of balloon tamponade in massive upper gastrointestinal haemorrhage

Case

You have been resuscitating the 62 year old man with a massive GI bleed from the previous post. You started your massive transfusion protocol and have him safely intubated. However, he continues to bleed, and you need to transfer him out of your small community hospital…

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Survival lessons for the emergency department

Survival lessons from the book “Deep Survival: Who lives, who dies, and why” adapted for the ED

Deep Survival: Who Lives, Who Dies, and Why” by Laurence Gonzales is a book about life and death. It explores disasters – at the top of mountains, in the middle the ocean, in the most remote wilderness – and examines why some people live while others die. Gonzales concludes with book with some advice designed to help readers survive. As I read his advice, I was struck by how applicable it is to the practice of emergency medicine. These are his survival lessons, adapted for the ED: Continue reading “Survival lessons for the emergency department”

Management of life-threatening hyperkalemia

A brief guide to the immediate management of severe hyperkalemia in emergency medicine and critical care

Case

An 82 year old man with a history of end stage renal disease, hypertension, coronary artery disease, and prior admissions for hyperkalemia is brought in by EMS with a history a 3 days of nausea, diarrhea, and fatigue, culminating in a witnessed collapse and a brief bout of bystander CPR. When the paramedics arrived on scene, he had a weak pulse and was only responding to painful stimuli. The ECG en route revealed a very strange appearing wide complex bradycardia, almost like a sine wave, and a VBG reveals a K+ of 9 mmol/L…

First10EM Hyperkalemia ECG K9.9 from Life in the Fastlane.jpg

#FOAMed Medical Education Resources (LITFL) / CC BY-NC-SA 4.0


Continue reading “Management of life-threatening hyperkalemia”