Supplemental Oxygen: a cautionary tale.

You’re working in the Cardiac Room as a new PGY-2 and the triage nurse calls you to evaluate a patient. He’s about 40 years old, slightly overweight, known to the ED for chronic alcohol abuse, and appears to be intoxicated yet again.The nurse tells you that when she checked his vitals, his O2 sat wasRead more

Steroids for everyone?

Of course your asthma patients with acute bronchitis will get some steroids….but what about your non-asthmatic patients?  Evidence shows that most patients with acute bronchitis do not need steroids. What’s the evidence? Study: double-blinded RCT of 401 patients with lower respiratory tract infection symptoms (wheezing) without history of asthma or COPD treated at different familyRead more

Dex or Pred?

Is one dose of PO dexamethasone enough or do you need to send your adult asthmatic patient home on a 5 day oral prednisone course? A noninferiority study published in Annals of Emergency Medicine in 2016 says maybe it doesn’t matter. What was the study? Adult ED patients ages 18-55 were randomized to receive eitherRead 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

Doc… I’m drowning!

You are called to triage to assess a man for shortness of breath. Per EMS, this is a 46 year old male with a history of substance abuse and HTN, found by his wife this afternoon, overdosed on Heroin and barely breathing. EMS arrived on scene to find him unconscious, with a RR of 5Read 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

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

The 52 in 52 Review: CRB-65 predicts death from community-acquired pneumonia

“I quit school in the sixth grade because of pneumonia. Not because I had it, but because I couldn’t spell it.” – Rocky Graziano   Article Citation: Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul;260(1):93-101. PMID: 16789984   What weRead more

The 52 in 52 Review: Noninvasive ventilation for acute pulmonary edema

“There is nothing like the cure of fresh air for cases of bladder infection, paranoia, and Cartesian thinking.” -Rawi Hage   Title: “The 52 in 52 Review: Noninvasive ventilation in acute cardiogenic pulmonary edema”   Article Citation: Masip J, Roque M, Sánchez B, Fernández R, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematicRead more

High Altitude Illnesses, part 2

Yesterday, we learned about acute mountain sickness (AMS) and high altitude cerebral edema (HACE). Today we will tackle high altitude pulmonary edema (HAPE), the deadliest of the altitude illnesses. HAPE generally occurs above 3000m, but incidence varies at different altitudes. At 4500m the incidence ranges from 0.2 to 6%. Factors that place people at increasedRead more