Resist the urge to administer a large crystalloid bolus in hypotensive trauma patients. Doing so worsens coagulopathy and acidosis. This practice should be abandoned. Normotensive trauma patients need no fluid resuscitation. The practice of permissive hypotension in trauma improves has been demonstrated to improve morbidity and mortality (selected references below). Hypotensive trauma patients require surgical […]

It’s well known that the risk of venous thromboembolism is increased during pregnancy.  It is thought to be two-to-six times higher than the risk in non-pregnant women.  However, these risk estimates are based on pregnant populations that go on to deliver a baby.  Last year Ray et al. published a paper describing their findings on […]

A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study the use of bag-mask ventilation to prevent hypoxemia during intubation.  401 patients were randomized to either bag mask ventilation or no […]

At the request of department leadership, we will be revisiting methods of gastric decontamination for today’s pearl.  Two methods in particular. Ipecac-induced emesis and gastric lavage are two procedures that we read about in medical school and in textbooks but never utilize in practice.  They are both considered techniques of “gastric emptying” (GE) as opposed […]

Today we will review complications associated w/ implanted pacemakers that you may encounter in the ED and thus ought to be familiar with. Generally, complications can be divided into two categories: early vs. late Early complications typically occur in the first 6 weeks and are related to the implantation procedure itself: venous access, lead positioning, tissue […]