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Hurry Up & RUSH!

You’re working in RESUS, and you get a notification for hypotension. He’s a 65 year old male noted to be hypotensive to 70/40 by EMS. On arrival, he’s altered and unable to provide any history, and EMS doesn’t have much more information. You don’t see any signs of trauma. Your attending suggests performing a RUSHRead more

The Neuroprotective Intubation

Bottom line up front: (1) Intubating those with TBI or spontaneous ICH is dangerous. You want to prevent increased ICP that is caused by laryngoscopy. (2) Pre-treat with fentanyl if time and the pt’s BP allow. The dose of fentanyl is larger than we are used to, dose 3 mcg/kg (or ~150-200mcg). (3) It isRead more

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

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

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

Can there possibly be a debate about cardiac standstill? And what is Kappa?

A study done by some of our favorite residents and attendings says there is a debate! They surveyed physician sonographers at 6 conferences in 3 academic medical centers in NY.  Each person was given 20 seconds per slide to determine whether each of the 15 video clips of patients in cardiac arrest were standstill orRead more

A Whole New World

We all love FOAM, and we all love airway. Today’s pearl will introduce you to a corner of FOAM you may not have come across, as well as a corner of airway management you might not know about. I’m a big fan of Jed Wolpaw’s Anesthesia and Critical Care Reviews and Commentary podcast. Many ofRead more

Oops…is that part important?

There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube. This happened to me twice in my PGY2 year. Obviously, this ETT will need to beRead more

52 in 52: The Rivers Trial

Title: “The 52 in 52 Review: Early goal-directed therapy in the treatment of severe sepsis and septic shock” Article Citation: Rivers E, Nguyen B, Havstad S, Ressler J, et al; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. PMID:Read more