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In: Critical Care, Infectious Disease, Journal Club

Methodology: 4/5 Usefulness: 3/5 Fujii T, et al. JAMA. 2020 Jan 17. doi: 10.1001/jama.2019.22176. [Epub ahead of print] Editorial: Lack of Benefit of High-Dose Vitamin C, Thiamine, and Hydrocortisone Combination for Patients With Sepsis. Question and Methods: International, multicenter, open-label RCT to determine whether HAT (hydrocortisone, ascorbate, thiamine) compared withRead More →

PEA

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In: Airway, All Posts, cardiac arrest, Critical Care, Featured, Grand Round Summaries, Resuscitation

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 →

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In: Critical Care, Mass Casualty / Disaster, Pre-Hospital, Trauma

Blast injuries resulting from explosions have the capacity to cause life-threatening multisystem injuries in multiple victims simultaneously. The biggest potential challenge in managing blast injuries is the creation of large numbers of simultaneous critically ill casualties. Once notified of a possible bombing or explosion, Emergency Physicians should immediately consider activatingRead More →

Clam Shell

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In: cardiac arrest, Critical Care, Procedural care, Trauma

Emergency Resuscitative Thoracotomy (ERT) is a potentially lifesaving intervention. It is a true salvage procedure, without which survival is essentially zero, even in indicated scenarios. After reading this post, you’ll be slightly more comfortable should you ever find yourself in a situation where you need to “crack the chest” (i.e.Read More →

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In: Airway, Anesthesiology, Critical Care, Journal Club, Resuscitation

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 →

consent

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In: cardiac arrest, Critical Care, Grand Round Summaries, Patient Advocacy, Resuscitation

In the second part of this two-part series, Dr. Michael Wong discusses the process for obtaining consent for incapable persons in the Emergency Department. For a review of a rational and patient-centered approach to difficult discussions in the Emergency Department around goals of care and resuscitation, please see the firstRead More →

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In: Critical Care, Full Article, Infectious Disease, Journal Club

Journal Club Summary Methodology: 3/5 Usefulness: 3.5/5 Annane D, et al. N Engl J Med. 2018 Mar 1;378(9):809-818.  Editorial: A Role for Hydrocortisone Therapy in Septic Shock? Question and Methods: Large multi-center, double-blinded, randomized-controlled trial comparing effects of steroids (fludrocortisone + hydrocortisone) to placebo on 90-day mortality of ICU patientsRead More →