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Post-Intubation Sedation

Post-intubation Sedation – Tips for the Intubated Patient You’ve just finished intubating your hypotensive, acute respiratory failure patient. Other than the pharmacologic and hemodynamic considerations, what other things should inform your choices for post-intubation sedation?   I thought I knew about post-intubation sedation since intern year; what’s new? Though not brand new, the latest SocietyRead more

Edible Arrangements: What You Need to Know About Edible Marijuana

In recent years, a number of states have decriminalized marijuana for medical use, and some have even decriminalized recreational use. This trend is likely to continue. Much of this marijuana – particularly when used recreationally – is consumed as edible products. For our last pearl together, we’ll talk about marijuana, edibles, and some important thingsRead more

The 52 in 52 Review: Targeted Temperature Management

Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197-206.   What we already know about the topic: Patients generally have poor survival and neurologic outcomes after out-of-hospital cardiac arrest. After two studies in 2002 showed improved outcomes in patients with out-of-hospitalRead more

Digoxin Day, Part 2: Digoxin and ECGs

Welcome to Digoxin Day, Part 2! Like all sequels, this is sure to be even better than the original.   Cardiac Physiology of Digoxin: Cardiac glycosides increase parasympathetic tone by acting on the vagus nerve. They also depress myocardial tissue. Together, these actions cause a decreased rate of depolarization through the SA node and aRead more

Digoxin Day, Part 1: Calcium and Hyperkalemia

Digoxin is a cardiac glycoside, and it has a narrow therapeutic window (0.5-2 ng/ml). Due to its sub-milligram dosing, its dependence on renal clearance, and its interactions with many other drugs, digoxin toxicity is a real concern for patients taking this medication.   Digoxin and hyperkalemia: Hyperkalemia is frequently seen in the presence of digoxinRead more

Eye on the Prize: Can You Perform a Lateral Canthotomy?

When a patient presents with orbital compartment syndrome, performing a lateral canthotomy and cantholysis can be vision-saving. You may only have 60-100 minutes until the patient experiences permanent visual sequelae. Are you ready?   Indications: Indications to perform lateral canthotomy may be remembered with the mnemonic DIP A CONE. They include decreased visual acuity, intraocularRead more

The 52 in 52 Review: Sgarbossa Criteria

Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med. 1996 Feb 22;334(8):481-7.   What we already know about the topic: When a patient presents with acute myocardial infarction (AMI), time is myocardium – that is, the patient shouldRead more