Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs

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 pending CTPE, subdivided in (1) HR≥100 BPM and/or sBP <90 mmHg, […]

Let’s talk about some drugs

Here, we seek to explore some controversial, poorly known, or irrelevant drugs in medicine in a menagerie of drug cocktails. 1. What drugs best treat SVT? A patient presents with the following rhythm strip, they’re totally stable, on no medications and with no significant medical problems. Take a minute, think about how you are going to treat it. Thought about […]

Braving the Electrical Storm in the ED

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 on whether or not the patient has an ICD (an implantable […]

Sepsis and Septic Shock

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 both macrocirculatory (blood pressure) and microcirculatory markers (lactate) when treating patients. […]

Guidelines for Emergency Airway Management of COVID-19

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 patients in the ED – whether under the care of Emergency […]

Hypothermia Part 2: Prognostication and Protocols

Here we present part two on our series on hypothermia. For more on the assessment, resuscitation, and management of the hypothermic patient, see part one. Prognostication of cardiac arrest in hypothermia Indicators of cardiac arrest before cooling (Brown 2012) Major trauma Witnessed normothermic arrest Avalanche burial <35 min Patients with primary hypothermia and cardiac stability who have been treated with […]

Hypothermia: Keeping your cool when it gets cold

Hypothermia results in slightly over one hundred deaths per year in Canada; typically as a result of primary hypothermia, frostbite and other cold exposure injuries (Toronto Public Health, 2014). In the United States, this is estimated at 1500 deaths annually (Baumgartner 2008). Both are likely underestimates of the scope of illness, as it only represents patients brought to a hospital, […]

Emerging Updates in Septic Shock

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 already changed the way we care for patients with sepsis and […]

Management of PEA: in need of 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 is a spectrum of disease Imagine a spectrum, where on one […]