I love this kind of case, the patient isn’t offering us much to go on but they are really complicated and deteriorating…what do you want to order and assess first? Can we ever anticipate everything-obviously not, but I like to try!
Great reminder of the various poisoning acronyms!
Ethylene Glycol Poisoning
We know ketamine is the answer to everything in the Emergency Room setting-right?
When we think about why we are giving the RSI drugs “rapidly” it makes sense to think about onset and how apnea and unconsciousness will affect the order of administration.
Here is a great post from PulmCrit on RSI drug administration times and pharmacokinetics!
PulmCrit- Rocketamine vs. keturonium for rapid sequence intubation
Sometimes I post because I woke up at 3am thinking about something random. This is completely one of those moments. The day before we had been talking about ECMO and the timing of giving heparin. I wondered then what affect the ECMO circuit must have on the medications. Lucky for me it was just a quick search away because the smart folks at LITFL had already thought about this!
If you have ever wondered (at 3am or otherwise)how medications are affected by ECMO then this is a great place to start reading.
Pharmacokinetics and ECMO
A super helpful guide for understanding pacemakers-which sums up almost everything you may have ever wondered about pacemakers and how they function. The second link is a guide to interpretation of the pacemaker ECG-which I found to be much more straightforward after reading that post!
Pacemaker Essentials: How to Interpret a Pacemaker ECG
This post is a great review of the mechanism of ped struck and the injury patterns to be watching for in these patients. Something most of us ER staff take for granted. This post puts it together very well and keeps it simple enough to be worth your time.
Pedestrian Struck by Vehicle: Pearls and Pitfalls of ED Management
Managing LVAD patients in the Emergency Department is complicated even if you see them fairly often. Here are a few resources to keep you calm and to review the basic highlights.
LVAD Patients: What You Need to Know
How to Manage Emergency Department Patients with Left Ventricular Assist Devices
I have often felt like we stop too often in arrests for a variety of factors. Maybe I am just old school? Maybe I have read way too much about intrathorasic pressure being important in survival outcomes? I feel like since POCUS came on the scene we are often stopping to look at the heart during the arrest. Of course this has value on several levels but it’s a fine line. This article provides a limited study but more than anything we need to be aware of our time off chest.
How long and how often is a rhythm check/cardiac US viable? Should we do them more/less often and pause compressions to confirm cardiac standstill? Does it change the outcomes?
Impact of US Guided Cardiac Arrest Resuscitation on Compression Pauses
An excellent review of the very sick renal patient. Is dialysis the answer?
emDocs Cases: The Sick ESRD Patient
What are we doing to decide and how do we start? We know fluid is key in resuscitating septic patients but what if they are children? Are we ready for that challenge?
A good look at how to choose your fluids based on a large body of evidence and emerging trends in fluid resuscitation for our smallest patients.
Balanced vs Unbalanced Fluids in Pediatric Severe Sepsis
How to prevent further lung damage with ventilation strategies. A great post for the RT’s and all the airway nerds like me!
The Benefit of Lung Protective Ventilation in the ED Should be LOV-ED