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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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Pericardiocentesis

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…

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Should we intubate in the ramped position?

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…

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Fixed Dilated Pupils

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…

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The Unstable Atrial Fibrillation Patient

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…

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Are You Still Feeling For A Pulse? Stop It!

I remember years ago when we used to manage cardiac arrests and everyone was asked to stop compressions while someone felt for a pulse. Do you remember that? “I think I feel one. I wonder if that’s mine? Can someone else feel please?” Meanwhile time with no CPR passed. Today with the push for cardiocerebral resuscitation…

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Pulseless Electrical Activity

Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be…

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Massive Propranolol Overdose

Massive propranolol overdose is perhaps one of the most challenging overdoses to manage. In 2009 we posted a case we had. We have progressed in our management since then. CASE A 26 yo woman is brought to the ED by ambulance. She has been found by her mother in her bedroom in a confused state….

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