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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

Burn Baby Burn

Happy 4th of July! I’m taking the day to review a commonly incurred injury on the holiday: burns. Whether it’s from operating a grill after a few too many libations or an unfortunate encounter with fireworks, the incidence of burns seems to go up dramatically on the 4th. While we mostly see minor burns inRead more

This week’s 52 in 52 Review

Title: “The 52 in 52 Review: Heparin plus TPA compared to Heparin alone for Submassive PE” Article Citation: Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W; Management Strategies and Prognosis of Pulmonary Embolism-3 Trial Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002Read more

Turn down the volume

On your busy resus shift you receive a EMS notification that a post arrest patient is en route, ETA 2 minutes. On arrival the patient is being actively bagged by EMS through an endotracheal tube placed in the field. He is hypotensive to 83/55 and tachy to 112. You confirm ETT placement with direct visualizationRead more