CMS recently produced a new sepsis measure/bundle that has many EM and critical care docs up in arms. I’m not going to focus on their definition of sepsis (save your rage for later), but instead on the fact that their definition of resusci…
by @benazan I recently caught up with Kit Tainter, 2011 SinaiEM grad. He’s now doing critical care in San Diego with both ICU and ED time, many people’s dream. Hear how he got there, his advice for finding a Crit Care job and mu…
You’re peacefully writing a note when you notice an incessant beeping from the back of your resus bay. It’s not a monitor, it’s a ventilator. What do you do? Press the silence button? Call respiratory therapy? As Dr. Weingart has said, v…
You’re treating an asthmatic 22-year-old. You give 5 back-to-back nebs, steroids and mag. When you reassess, she’s moving air better with minimal wheezing, but more tachypneic. Additionally, her lactate has climbed from 2 to 6.8 in 2 hou…
Do central line-associated bloodstream infection (CLABSI) rates differ based on whether they were placed in the ED versus the ICU? A recent article published in Academic Emergency Medicine attempted to answer this very question. Central lin…
The current Surviving Sepsis Campaign guidelines recommend starting either dopamine up to 10mcg/kg/min or epinephrine 0.05 mcg/kg/min for pediatric patients suffering from fluid-refractory septic shock. There is a significant lack of eviden…
Cardiac tamponade is a condition in which there is life threatening compression of the heart as a result of external pressure from the presence of fluid, gas, pus, clots, or blood in the pericardial space.
A 43-year-old patient arrives to the ED complaining of palpitations. Vitals are HR 298, BP 107/74, SpO2 100% RA, RR 18. The patient is diaphoretic, uncomfortable appearing, and heart sounds are fast and irregular. You obtain an EKG which sh…
You are evaluating a 65yo male with PMH CHF presents with severe sepsis. You’d like to administer IV crystalloids but you’re not sure how much should be given. What are some tools to assess for fluid responsiveness?
You are managing an elderly patient with septic shock. The ICU team is requesting ScvO2 measurement to be used in consideration of inotropic support. You are not sure how to make decisions about inotropes based on ScvO2 and wonder: What…
One of your patients arrived with stroke and was treated with tPA. On reevaluation the patient reports a new severe headache and then becomes lethargic. What should you do?
59 y/o M presents to the cardiac room after cardiac arrest. EMS reports a downtime of 5 minutes with immediate bystander CPR. The initial rhythm was vifb that responded to two EMS shocks and CPR. The patient arrived with ROSC. Soon after th…
69 yo M with remote h/o CVA with residual aphasia and R–sided hemiparesis, BIBEMS from NH with concern for status epilepticus (SE). Per EMS, the patient began to have 3-4 episodes of generalized convulsive activity that began about 30 minut…
You are catching up on some charts in the resuscitation area of your ED when your triage nurse pushes in a 37 yo M with no PMHX, who presented to your ED complaining of sudden onset lightheadedness and L sided chest pain about 10 minutes PT…
A 19-year-old-male with no known past medical history, presents in progressive respiratory distress shortly after undergoing a tooth extraction about 6 hours prior to presentation. Symptoms began initially as “a lump in his throat” and diff…
