VV vs VA ECMO

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This is a great post about how these 2 types of ECMO compare and the indications for application of ECMO. Simply put VA offers full cardiac and pulmonary support while the more commonly used VV is only pulmonary support. This is a very useful overview. I am always looking for more informations about ECMO and applications for it!

 

ECMO (Extra-Corporeal Membrane Oxygenation)

Thoracotomy in traumatic cardiac arrest

There are only so many options in a traumatic cardiac arrest. Is the ED thoracotomy a reasonable fix to anything or are we just making a mess? The general rule is since the patient isn’t going to live if we don’t do it then it’s worth a try…

I like the way it is laid out here. I always appreciate really knowing what our goals are with such a dramatic and resource heavy procedure. This does a great job putting it into perspective.

Not for a second is the thoracotomy something any ED nurse or physician looks forward to but everything goes better if we think about it before we get there.

Traumatic Cardiac Arrest

 

Hilar Twists & Human Error

REBOA

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Resuscitation Endovascular Balloon Occlusion of the Aorta. Just as exciting as it sounds.  Another great tool in the war on exsanguination in trauma. A lot of factors to consider if we are occluding the aorta. Again something I enjoyed hearing about at a recent conference-as you might imagine the Trauma Surgeon talking about it made it sound pretty straight forward.

Does your ER have a kit for this or would you be scrambling for supplies? Have you seen it used?If you have read something great about it please add it to the comments.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Intranasal Medications in Pediatric Patients

Intranasal Analgesia for kids. Important to add this to your pediatrics tool box in addition to a huge amount of patience and creativity.  This site is an excellent pediatrics resources in general but this post really stands out as a reminder of how we can and should do things differently with children.

 

Intranasal Analgesia

PECARN

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The best pediatric head trauma CT decision tool around. Does your department use it? Do you find it to be accurate?This is a great example of several great minds working together to make a tool that improves all of our Emergency Departments. I came across this at a recent conference and it was interesting to see how they compared it to CHALICE and CATCH as tools. According to the 2016 study comparing the 3 tools-PECARN came out way ahead at identifying TBI in children.

 

PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians

Here is the link to the study that i referenced.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731042/

Hypothermia and Overdose

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As that time of year approaches we start to see more and more of the mysterious “found down” patient,  was it drugs or alcohol, maybe both or could the decreased level of consciousness be entirely explained by the hypothermia?

These are the most complicated cases, lucky that we have some insight as to where we should start.

TOXCARD: Hyperthermia in the toxicological setting

Translating Emergency Knowledge for Kids

Hands down the best site for everything you every wanted to know about caring for kids in your emergency department. Resources, guidelines, recommendations and most importantly evidence about how to best treat pediatric patients in the ED setting. We use this site frequently in my ED and I would encourage you to check it out as an up to date and easily accessible resource.

TCA Overdose

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My favourite post on the complex management of the TCA overdose. As an ER nurse knowing that my patient has possibly overdosed on TCA immediately causes me to worry about what I might be missing. Although many patient’s are no longer on these drugs, they are still out there and they absolutely present a challenge to manage.

Here is an excellent post that summarizes it nicely and even offers some reasonable treatments to consider. Hopefully you are calling your Poison Control Centre ASAP too!

Podcast 98 – Cyclic (Tricyclic) Antidepressant Overdose

Beta Blocker Overdose

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It’s not really a secret- I love toxicology. It is just so complicated and interesting. My ED sees a lot of overdose but usually not from prescription medications. Recently I had a case where a patient had ingested what looked like a bag of skittles. The usual suspects such as zopliclone and seroquel but the really trouble was the metoprolol which my smart ER doc quickly picked out of the bag. It’s a hard thing to manage and absolutely not something you see every day (thankfully).

A short but sweet post on betablocker overdose. Not a ton of details on treatments but a good generalized look at your options.

Briefs: Beta Blocker Overdose