TXA in the Hemorrhaging Postpartum Patient

On your busy overnight trauma shift at Elmhurst, you are the provider during a precipitous vaginal delivery in the trauma bay at 2am. The infant is delivered without complication, and your Pediatric colleagues give you APGAR’s of 8 and 9. As you call up to L&D, you are told that the staff; attendings and residentsRead more

Hypothermia ECG

For our clinical pearl today I thought I thought I would do some basic ECG teaching. This is a real case that I saw with Carlo at Elmhurst in the cardiac room. As always, we will start with a clinical scenario. A middle-aged male with unknown medical history was brought to the emergency department byRead more

Awake Intubation Topicalization

Compiled from a variety of sources from #FOAMed (specifically, NYSORA and the ACCRAC podcast) and inspired by morning report today with Taryn and Tina, here is a quick and dirty rundown for awake intubation. Firstly, we should be considering this method when the two Venn diagrams of “anatomically challenging” and “enthusiastically cooperative” overlap in theRead more

How-To: Preoxygenation via SIMV Noninvasive Ventilation

Inspired by a morning report discussion from our very own Lara Vanyo on preoxygenation strategies, I thought it would helpful for a brief run-down on the button-pushing needed to perform preoxygenation by way of noninvasive ventilation. The video below is specific to the vents we have at Sinai–Weingart and Elmer have already shown us how toRead more

That Vitamin C in Sepsis Newsflash

A number of really bright people are still unsure of what to make about the vitamin C, steroids and thiamine newsflash that’s taken Twitter by storm yesterday. At Sinai here we’re the curious types, so we chatted with our pharmacist who similarly didn’t know what to make of the headlines given the lack of a randomizedRead more

Giving tPA to a patient on aspirin? What about aspirin and Plavix?

Does it matter if my patient getting tPA is on prestroke antiplatelets?   The neurology and ED teams have decided to give tissue plasminogen activator (tPA). As an outpatient, the patient is on aspirin and clopidogrel dual antiplatelet therapy. Does it matter that they’re on aspirin and Plavix? Does prestroke antiplatelet therapy in acute ischemicRead more

The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock

The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock   Article Citation: De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-89.   What We Already Know About the Topic: The recent 2016 Surviving SepsisRead more

Mechanical Ventilation Protocol in the ED

Citation Fuller BM, Ferguson IT, Mohr NM, et al. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial. Ann Emerg Med. 2017; Clinical Question Does a multifaceted, 4-part, ED-based mechanical ventilator protocol improve respiratory and ventilator-associated outcomes? The Short Version: Using a mechanical ventilation protocol (i.e., protective tidal volumes, appropriate PEEP, lowRead more

Hypertonic Saline or Mannitol for Head Injury?

Traumatic Brain Injury & Neurocritical Care You’ve just intubated your traumatic brain injury patient and the repeat pupil exam shows signs of herniation. In addition to your other interventions (e.g., Reverse Trendelenburg positioning, optimization of sedation/analgesia), do you reach for the hypertonic saline or mannitol as osmotherapy? What risks and benefits come with either therapy?Read more

High Flow Nasal Cannula Better Than Conventional Therapy

High-Flow Nasal Cannula for Avoiding Intubation?   Citation: Ni YN, Luo J, Yu H, et al. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation? A systematic review and meta-analysis. Chest. 2017   What We Already Know:Read more