Resus SinaiEM Blog – Page 31

High Flow Nasal Cannula Better Than Conventional Therapy

Posted on March 17, 2017 by Clark Owyang

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: […]

The 52 in 52 Review: Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy

Posted on March 16, 2017 by Clark Owyang

Article Citation: Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739-46. What We Already Know About the Topic: Lactate physiology can assist in triaging the severity of illness for septic patients. While the underlying pathophysiology can […]

Don’t Forget The Right Ventricle

Posted on March 14, 2017 by Clark Owyang

The Right Ventricle The right ventricle (RV) has been getting more coverage lately from the Wilcox et al review article in Annals to the continued coverage in many critical care circles where anesthesia and emergency medicine overlap.(1) Furthermore, the increased presence of VADs and physiology-centric thinking in the resuscitation units of the ED require facility […]

Post-Intubation Sedation

Posted on March 13, 2017 by Clark Owyang

Post-intubation Sedation – Tips for the Intubated Patient You’ve just finished intubating your hypotensive, acute respiratory failure patient. Other than the pharmacologic and hemodynamic considerations, what other things should inform your choices for post-intubation sedation? I thought I knew about post-intubation sedation since intern year; what’s new? Though not brand new, the latest Society […]

Edible Arrangements: What You Need to Know About Edible Marijuana

Posted on March 10, 2017 by Emily Taub

In recent years, a number of states have decriminalized marijuana for medical use, and some have even decriminalized recreational use. This trend is likely to continue. Much of this marijuana – particularly when used recreationally – is consumed as edible products. For our last pearl together, we’ll talk about marijuana, edibles, and some important things […]

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The 52 in 52 Review: Targeted Temperature Management

Posted on March 9, 2017 by Emily Taub

Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197-206. What we already know about the topic: Patients generally have poor survival and neurologic outcomes after out-of-hospital cardiac arrest. After two studies in 2002 showed improved outcomes in patients with out-of-hospital […]

Digoxin Day, Part 2: Digoxin and ECGs

Posted on March 7, 2017 by Emily Taub

Welcome to Digoxin Day, Part 2! Like all sequels, this is sure to be even better than the original. Cardiac Physiology of Digoxin: Cardiac glycosides increase parasympathetic tone by acting on the vagus nerve. They also depress myocardial tissue. Together, these actions cause a decreased rate of depolarization through the SA node and a […]

Digoxin Day, Part 1: Calcium and Hyperkalemia

Posted on March 6, 2017 by Emily Taub

Digoxin is a cardiac glycoside, and it has a narrow therapeutic window (0.5-2 ng/ml). Due to its sub-milligram dosing, its dependence on renal clearance, and its interactions with many other drugs, digoxin toxicity is a real concern for patients taking this medication. Digoxin and hyperkalemia: Hyperkalemia is frequently seen in the presence of digoxin […]

Eye on the Prize: Can You Perform a Lateral Canthotomy?

Posted on March 3, 2017 by Emily Taub

When a patient presents with orbital compartment syndrome, performing a lateral canthotomy and cantholysis can be vision-saving. You may only have 60-100 minutes until the patient experiences permanent visual sequelae. Are you ready? Indications: Indications to perform lateral canthotomy may be remembered with the mnemonic DIP A CONE. They include decreased visual acuity, intraocular […]

The 52 in 52 Review: Sgarbossa Criteria

Posted on March 2, 2017 by Emily Taub

Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med. 1996 Feb 22;334(8):481-7. What we already know about the topic: When a patient presents with acute myocardial infarction (AMI), time is myocardium – that is, the patient should […]

Alright, alright, alright: Arrhythmogenic Right Ventricular Cardiomyopathy

Posted on February 28, 2017 by Emily Taub

When you examine the ECG of a patient who syncopized, what are you looking for? You’re probably checking for a prolonged QT interval, signs of left ventricular hypertrophy consistent with hypertrophic obstructive cardiomyopathy, a delta wave consistent with Wolff-Parkinson-White syndrome, and T-waves suggestive of Brugada syndrome. But is arrhythmogenic right ventricular cardiomyopathy (ARVC) on your […]

Opioid Prescriptions in the ED: How Many People Have You Hooked?

Posted on February 27, 2017 by Emily Taub

To call opioid use in the US a “problem” is a gross understatement, and most of us in Emergency Medicine appreciate this. You may believe that if you only prescribe a small number of pills to an opioid-naïve patient who is truly in pain, you are not causing harm. A new study in the New […]

Topical Toxicology: VX Gas and Kim Jong-nam

Posted on February 24, 2017 by Emily Taub

*Thanks to Dr. Clark Owyang for following this “case” with me! On February 13, Kim Jong-un, son of Kim Jong-il and half-brother of current North Korean leader Kim Jong-un, was poisoned at Kuala Lumpur airport in Malaysia. He died shortly after. Yesterday, the Malaysian police reported that Kim Jong-nam died of exposure to VX […]

The 52 in 52 Review: Steroids for Bacterial Meningitis

Posted on February 23, 2017 by Emily Taub

De Gans J, Van de Beek, D. Dexamethasone in adults with bacterial meningitis. New Engl J Med. 2002;347(20):1549-56. What we already know about the topic: Bacterial meningitis is a dangerous condition with significant associated morbidity and mortality. Survivors often suffer neurologic sequelae. Bacterial meningitis frequently affects people who were previously healthy and high-functioning. […]

Singin’ the blues: What can you do with methylene blue?

Posted on February 21, 2017 by Emily Taub

Methylene blue (MB) is a heterocyclic aromatic compound, and a basic thiazine dye. We all know that it is used to treat methemoglobinemia. MB is an oxidizing agent, which becomes a reducing agent when NADPH reduces it to leukomethylene blue. It then reduces the iron in methemoglobin, changing it from the ferric (Fe3+) state back […]