This block’s EM-CCM was a fantastic review of a commonly seen problem at its extreme. For the sake of brevity we will review: Renal failure associated metabolic derangements Indications for urgent dialysis Treatment of hyperkalemia- this is our bread and butter To bicarb or not to bicarb Not all troponinemia Read more…
We discussed an informative and interesting review article on stroke management in October’s Critical Care Minifellowship meeting. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062315/ This article highlights some important points (that shed light on how complicated the brain truly is) and touches upon some interesting neurological trials. A few points to mention are: – The idea of Read more…
EM-CCM Conference on 6/18/14 Presented by Dr. Bonnie Brown Special Thanks to Dr. Gillette for his insightful comments and attendance. The Case 41 yo F pmhx Sickle Cell Disease presents 15 hours after onset of right face numbness, right arm numbness and weakness, and difficulty speaking. Stroke work-up performed including Read more…
EMS notification. 115 year old female in cardiac arrest. ACLS in progress. Estimated time of arrival: 5 minutes. Your stomach groans. Upon EMS arrival, you learn that she comes from a nursing facility and has end-stage dementia; she is bed-bound, contracted and non-verbal. Maybe she’s got a PEG tube or Read more…
EM-CCM CONFERENCE SUMMARY PRESENTED BY DR. PIA DANIEL SUMMARY BY DR. FRANCIS YOUN CASE: Elderly, bedbound, nonverbal female with past history of dementia, hypothyroidism, sigmoid volvulus s/p sigmoidectomy and colostomy sent from NH for altered mental status, fever, and concern for bowel obstruction. VS: T 103, BP 99/60, Read more…
EM-CCM Conference: January 2014 Presented by Dr. LoCascio Summary by Dr. Grock The Case: 67 yo F pmhx ESRD on HD, HTN with slurred speech and Left sided weakness starting at 19:30. H&P and work-up significant for BP 208/95, R gaze preference, L facial droop, decreased strength to LUE/LLE. Read more…
The debate on the treatment of circulatory shock is over(-ish?). Ever since the NEJM put out its big RCT on the treatment of all-comer shock[i], we know that norepinephrine is the vasopressor of choice. Septic, cardiogenic….doesn’t matter. Norepinephrine is superior to dopamine. Bummer, right? Choice of vasoactive agent was so Read more…
Thanks to Dr. LoCascio for today’s Morning Report! Out-of-Hospital Cardiac Arrest AMA Council on Ethical and Judicial Affairs states that CPR may be withheld, even if requested, “when efforts to resuscitate a patient are judged by the treating physician to be futile.” ACEP “physicians are under no ethical Read more…
Here’s Dr. DiMare with another Morning Report! Fibrinolytics for Suspected PE in Cardiac Arrest tPA in cardiac arrest seems like a great idea – 81% are from MI and PE – only 2-10% survival in out of hospital arrest When should you give it? – Current literature Read more…
ED Critical Care Conference: Sept 2013 The Curious Case of AMS with an (initially) Normal CT Head presented by Dr. Andy Grock Case: 24 yo M, no pmhx presents AMS s/p assault. MRI shows Diffuse Axonal Injury. TBI Discussion Severity by GCS Mild >13 Moderate >9 and <12 Severe <8 Read more…