Methodology: 2.5/5 Usefulness: 3/5 Daley JI, et al. Acad Emerg Med 26 (11), 1211-1220 Nov 2019 Questions and methods: In patients with abnormal vital signs, what is the sensitivity of FOCUS for the diagnosis of PE? Prospective, multicenter, observational study. Findings: 136 patients with pendingRead More →
This post takes a deep dive into the pathophysiology, presentation and management of electrical storm in the emergency department. The management focuses on patients with implantable cardioverter-defibrillators receiving multiple shocks, patients with polymorphic ventricular tachycardia and refractory ventricular fibrillation. Electrical storm (ES) has varying definitions in the literature depending onRead More →
The Surviving Sepsis Guidelines define sepsis as a “life-threatening organ dysfunction caused by a dysregulated host response to an infection”. Septic shock is further defined as sepsis with hypotension (MAP ≤65) and/or lactate ≥2.0 despite adequate fluid resuscitation(1,2). This definition of septic shock highlights the importance of factoring in bothRead More →
In this post, we aim to highlight the perspectives of family, physicians, the emergency department and pre-hospital medicine in regards to organ donation. Types of Organ Tissue Donation There are 2 main types of deceased organ donation including neurologic determination of death and donation after circulatory determination of death. NeurologicRead More →
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 →
In September 2018, Dr. Bram Rochwerg and I wrote a blog post on the treatment of patients with sepsis and septic shock. Much of this was based on the 2016 Surviving Sepsis Campaign (SSc) Clinical Practice Guidelines [1]. However, in a little over a year, significant new research has alreadyRead 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 →
Dr. Reardon and colleagues identify key management priorities in optimizing the early resuscitation in patients after out of hospital cardiac arrest. Read More →
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 →
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 →