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Capnography

Understanding capnography and being able to decipher the waveforms, can give us critical information on a patient’s condition, early. Below are 3 cases, where we look at some of the potential waveforms we might encounter in the intubated patient in the emergency department. What does it tells us? Capnography gives information on: Metabolism: Responsible for the…

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Should we bring Bretylium back in cardiac arrest?

Following a brief presentation at EMCore Hong Kong in April of this year, that challenged our thinking, I have asked our expert colleague, Dr Will Davies, to expand on an argument he put forward, (in our clinical topics series), that we should revisit the use of bretylium tosylate in cardiopulmonary resuscitation, especially in the treatment of…

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Apnoeic Oxygenation in Resuscitation: Is it time?

We are finally seeing the years of airway in resuscitation dogma being challenged. The original approach to airway which mandated intubation and probably led to significant delays in CPR and an increase in mortality, are now gone. Bag-valve-mask vs supraglottic vs intubation The literature that compares intubation, laryngeal mask(LMA) and bag valve mask(BVM) has given…

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Head-Up CPR

You may have heard of Head-Up CPR as a new approach to patient positioning during CPR. It may not be totally prime-time yet(although it is being used right now), but it is, thinking outside the box and concentrating on the most important part of what cardiac resuscitation is about…. saving the brain. If we go…

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Resuscitation:The Outer limits

Resuscitation is reaching new limits, with new techniques and technologies giving results that we never thought possible. In Lazarus-like fashion, patients that a few years ago, would have been pronounced deceased, are now leaving hospital to resume their lives, with their families and their work and with very little, if any, deficit. About 8 years ago I…

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Will Paramedic-2 change my practice?

If you haven’t caught the newly published Paramedic-2  trial, here’s a brief rant that tells you everything you need to know. The ostensible reason for the publication has been the ongoing debate about the role of adrenaline in cardiac arrest. In fact the very first line of the paper reads “concerns about the use of…

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Intraosseous Access Results In Decreased Survival In Cardiac Arrest

A new study shows a decreased survival in out of hospital cardiac arrest(OHCA) when intraosseous(I/O) access is used instead if intravenous(IV) access as a means of delivering fluids and medications. I/O lines provide rapid access where IV is not available and are progressively being used as the first line of access, primarily because they are quick, easy, don’t interfere…

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Myocarditis

Myocarditis is simply an inflammation of the heart muscle, that can lead to myocardial cell damage, myocardial dysfunction and heart failure. A Recent Case A 15 yo male presents to the emergency department with sharp central chest pain that is worst on inspiration. The pain has woken him from sleep. There is no radiation although…

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Should We Shock Patients in Asystole?

Should cardiac arrest patients in asystole be shocked? Is there any advantage to this? What do we know about asystole in cardiac arrest? Patients in asystole are known to have a very poor prognosis, with 0% to 2% surviving to hospital discharge. There is a slightly better prognosis if the rhythm converts spontaneously to a shockable rhythm…

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Rapid IV Fluid Administration Does NOT Affect Neurological Outcome in Children with DKA

HOT OFF THE PRESS: A new clinical trial showing that rapid IV fluid administration does not affect neurological outcome in children with DKA, as has previously been thought. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med 2018; 378:2275-2287 The Numbers This was a randomised controlled trial in 13 centres….

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