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 →

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 →