Guiding Principles Suspected SARS-COV-2 patients showing signs of hypoxemic respiratory failure should be intubated proactively, as early as possible. Signs may include FiO2 requirement > 50%, clinical signs of respiratory fatigue despite supplemental oxygen, or hemodynamic instability. Do not wait for rapid deterioration to act! Such unstable respiratory failure patientsRead More →
What is pulseless electric activity (PEA)? Pulseless electrical activity is diagnosed based on a patient having an organized, non-shockable rhythm and no palpable pulse. However, PEA is not always a cardiac arrest state. In many cases, patients with PEA have underlying cardiac activity and detectable arterial blood pressure.1 PEA isRead More →
Here we seek to provide a guide on when to consider awake intubation in the Emergency Department (ED), with an approach to the procedure! The Difficult Airway When assessing patients who may require any form of airway intervention, we should be assessing for two main entities: Difficult anatomy. Ask yourself:Read More →
Patients with both burn and inhalation injuries have significantly increased morbidity and mortality compared to those with just burn injuries alone, as there are multiple toxic industrial chemicals that act on the respiratory tract. In this post, we review inhalational injuries and the most common Toxic Industrial Chemicals leading toRead More →
Journal Club Summary Casey JD, et al. N Engl J Med. 2019 Feb 28;380(9):811-821. Methodology Score: 3.5/5 Usefulness Score: 3.5/5 Question and Methods: Multicenter, unblinded RCT in 7 ICUs comparing rates of hypoxia in patients undergoing BVM vs no ventilation during the period between induction and laryngoscopy. Findings: Compared to no ventilationRead More →
Securing definitive control of a threatened airway is a fundamental skill in the care of critically ill patients and remains an ever-popular topic of discussion in Emergency Medicine. As Emergency Medicine providers, we find few procedures as satisfying or potentially difficult as airway management; we continually seek to hone ourRead More →
A checklist is a physical, cognitive aid that lists essential actions required for a task to compensate for limitations in human memory. While checklists have been around forever, the concept of checklists in medicine is much newer. Medical checklists have been gaining popularity and appearing on social media, but isRead More →
Journal Club Summary Methodology: 4/5 Usefulness: 3.5/5 Wang HE, et al. JAMA. 2018 Aug 28;320(8):769-778. Editorial: Pragmatic Airway Management in Out-of-Hospital Cardiac Arrest. Question and Methods: This multicenter pragmatic cluster-crossover randomized trial compared initial advanced airway strategy effectiveness between laryngeal tube (LT) and endotracheal intubation (ETI) in adults with OHCA. Findings: The LTRead More →
Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 2.5/5 Jabre P, et al. JAMA. 2018 Feb 27;319(8):779-787. Question and Methods: This was a multicenter randomized trial comparing bag valve mask ventilation with endotracheal intubation performed by emergency physicians in 2043 patients with out-of-hospital cardiac arrest in France and Belgium Findings: Their primary outcome ofRead More →
In this two part series, we are delving into a few of the many controversies regarding procedural sedation and explore how to reduce resource utilization and ED length of stay. In PART 1, we discussed preprocedural fasting and concluded that adherence to fasting guidelines is unnecessary in healthy patients undergoing proceduralRead More →