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 →

goals of care

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

In this two-part series, Dr. Michael Wong begins by reviewing a rational and patient-centered approach to difficult discussions in the Emergency Department around goals of care and resuscitation. In part two, we discuss the process for obtaining consent for incapable persons in the Emergency Department. Common pitfalls with the currentRead More →

tactical combat casualty care

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In: Critical Care, Pre-Hospital, Trauma

The Tactical Combat Casualty Care (TCCC) Guidelines are the standard of care for the modern battlefield. TCCC offers operational guidelines for a range of combat personnel – from recommendations for all combatants to combat paramedics and SOF medics. Though these guidelines represent years of cumulative civilian and battlefield experience andRead More →

hydrocortisone

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In: Critical Care, Featured, Full Article, Infectious Disease

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 →

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In: Critical Care, Full Article, Journal Club, Neurology, Neurosurgery

Journal Club Methodology Score: 4/5 Usefulness Score: 3/5 Sprigg N, et al. Lancet. 2018 May 26;391(10135):2107-2115 Question and Methods: Multicenter, double-blinded, randomized, placebo-controlled trial comparing if IV TXA vs placebo, given within 8h of spontaneous (non-traumatic) ICH onset, decreased death or dependence at 90 days. Findings: No difference in 90dRead More →

mechanical CPR

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In: cardiac arrest, Critical Care, Featured, Grand Round Summaries, Pre-Hospital, Resuscitation

Mechanical CPR is a technology whereby a machine performs chest compressions in place of a human provider. These devices are becoming increasingly prevalent in the prehospital and in-hospital arenas, and it is inevitable that healthcare providers will interact with them in some capacity. Given the variable evidence in the literature,Read More →

damage control

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In: Critical Care, Featured, Pre-Hospital, Resuscitation, Trauma

Hemorrhage is the leading cause of preventable death on the battlefield. Damage Control Resuscitation (DCR) works synergistically with Damage Control Surgery (DCS) and prioritizes non-surgical interventions that reduce morbidity and mortality due to trauma and hemorrhage. DCR aims to restore homeostasis and prevent or mitigate tissue hypoxia and coagulopathy. ThisRead More →

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In: Airway, cardiac arrest, Critical Care, Featured, Full Article, Journal Club, Pre-Hospital

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 →

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In: cardiac arrest, Cardiology, Critical Care, Journal Club, Resuscitation, Ultrasound

Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2/5 Atkinson PR, et al. Ann Emerg Med. 2018 Oct;72(4):478-489 Question and Methods: This was the first multicenter, prospective, RCT examining the effect of POCUS on 30-day survival of undifferentiated hypotensive patients presenting to ED. Findings: There was no important survival benefit with theRead More →