How Safe is Mechanical CPR?

Question – How safe is mechanical CPR compared to manual CPR? There are two devices used for mechanical CPR – the AutoPulse and LUCAS – neither of which has been demonstrated to show a survival benefit over manual CPR in recent studies (CIRC, LINC, PARAMEDIC). Could these devices be causing more injuries compared to manualRead more

Novel Uses of Ultrasound in Cardiac Arrest

Question – How can you use ultrasound to figure out the etiology of a cardiac arrest? Much of the buzz surrounding ultrasound in cardiac arrest revolves around the intra-arrest echo and TEE. You can also use ultrasound to get some information about the etiology of the arrest. Enter the SESAME Protocol, developed by Daniel Lichtenstein (akaRead more

What Patients Require Emergent Cath Lab Activation?

Question – STEMI criteria are insensitive for all cases of acute coronary artery occlusion. Among patients with chest pain, what are the other criteria for cath lab activation? Let’s talk more ACS. Patients that need emergent reperfusion therapy are those that have an acute coronary occlusion. ECG findings of ST-elevation will not catch all cases ofRead more

The Echo in ACS

Case – 70 year old male mhx of HTN, IDDM presents with 2 hours of exertional chest pain. His ECG in triage is unremarkable for any ischemic changes. He appears uncomfortable and over the next 30 minutes requires escalating doses of nitroglycerin for chest pain. A repeat ECG is unchanged. You decide to echo himRead more

Capsaicin cream for treatment of cannabinoid hyperemesis syndrome

Case: 24yo male p/w abdominal pain, nausea and vomiting. This is his 4th ED visit in the past two months. He has had multiple workups including labs, abdominal ultrasound and CT, all of which were normal. He even followed up with a gastroenterologist recently who prescribed pepcid, but he continues to have recurrent symptoms. HeRead more

Reduction technique for Nursemaid’s elbow

It’s another busy afternoon in the peds ED when grandma comes in stating that her grandson broke his arm. He was jumping on the bed, and reached out to grab hold of a side rail before falling to the ground. It looks normal, but now the little guy refuses to use the arm and isRead more

Post-Intubation Care for the Critically Ill Asthmatic

Clinical Question – What is the best way to intubate and provide post-intubation care for the critically ill asthmatic? Case: 54M mhx asthma (hx of 2 intubations, last 2 months ago) presents to the cardiac room in respiratory distress. He fails nebs/steroids/mag and becomes obtunded after you trial bipap. A decision is made to intubate theRead more

High Flow

Clinical Question – Why use High Flow Nasal Cannula? When should you use it over BIPAP? HFNC offers several advantages compared to conventional oxygen therapy, including: Ability to deliver O2 at up to 60 LPMs at nearly 100% FiO2. This is huge compared to regular Nasal Cannula (1-6 LPMs, maxing out at 45% FiO2) and NRBRead more

A Young Man Presents with Syncope

Case – 26M with no medical history presents with chest pain and palpitations. He states that he passed out while walking. He denies associated symptoms or family history of sudden cardiac death. ECG: Question – What are the ECG abnormalities noted here? Diagnosis and Workup? ________________________________________________________ Answer – Arrhythmogenic RV Dysplasia. This is the second mostRead more

Improving Your Echo Game

Clinical Question – What’s a systematic approach you can use to improve your Echo? Case – 66 M with IDDM, HTN, and obesity presents to Resus in septic shock. He is intubated for hypoxemic respiratory failure, and remains persistently hypotensive despite a fluid-challenge and 15 mcgs of levophed. You slap on the probe to evaluate his EF. Here’sRead more