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…
The Case It was a quiet Sunday afternoon in a small ED (sounds like the start to a bad story, doesn’t it?) I picked up the next chart…30-year-old, 13/40, light PV bleeding History – otherwise healthy 30 year old, no medications, G2P1, 13/40, light bleeding since yesterday, some cramping low abdominal pain, USS at 10/40…
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…
ADRENALINE AND CARDIAC RESUSCITATION How much to use, when to use it and when not to use it. The resuscitation guidelines were born in the black-and-white television era, at the end of the 1950’s. The use of 1 mg of adrenaline which initially came from canine models, was introduced at this time and has been…
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…
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…
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…
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….
How to Perform Pericardiocentesis Pericardiocentesis is used to treat symptomatic pericardial effusions and cardiac tamponade. It was first described in the 1650’s and since the introduction of the subxiphoid approach in 1911, has been used very successfully, with significant reduction in morbidity and mortality. The use of echocardiography and other guidance techniques have reduced the…
I’ve spoken on awake intubationat the EMCORE Conferences, especially at the last Masterclass. I also spoke about the potential benefits of intubating patients in the ramped positionie., head of the bed up at 25-30 degrees. Mostly this is based Off studies, using operating theatre patients that have already been intubated, then disconnected from oxygen sources and observed to see how long…
Head injury with fixed dilated pupils: Are we done? We have looked at the pupillary response before on this blog in terms of the Doll’s Eye Reflex in brainstem death and the oculocephalic reflex. However, what if the pupils are fixed and dilated? We seem to learn quite early in our medical careers that fixed…
THE CASE A 75 yo man is brought into your small rural ED after 3 hours of ischemic chest discomfort. His background is significant for hypertension, a CVA 5 years ago for which he is on aspirin/dipyrimidole, and 2 coronary artery stents in 1995. The ambulance officers found the patient to be in AF, with…
