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Infuse > push

We always love a ketamine article here so no surprise we're infusing rather than "pushing" this one. Thanks to Journalwatch for this review.


Low-Dose Ketamine for Pain: IV Push or Slow Infusion? Daniel J. Pallin, MD, MPH Reviewing Motov S et al., Am J Emerg Med 2017 Mar 3; Neuropsychiatric side effects were more common with intravenous push administration, but does it matter? At intravenous (IV) doses of 0.1–0.3 mg/kg, ketamine is a safe and effective analgesic. Adverse effects are minimal and include sedation and a feeling of disconnection from reality. Investigators compared the effectiveness and adverse effect burden of ketamine administration by IV push versus slow infusion in a randomized, placebo-controlled, double-dummy trial. Forty-eight emergency department patients with acute pain received 0.3 mg/kg of IV ketamine given either over 5 minutes by push or over 15 minutes by infusion. Feelings of unreality (quantified using the Side Effects Rating Scale for Dissocia…

Webucation 28/2/17

This shot of Webucation includes sonography, pulmonary physiology, old school physics and even some etiquette advice. All credit to the original content providers.Hocus POCUS in cardiac arrestThings that scare me"Back to school" mathematics on closing velocityImpact of rudeness on medical teamsDoctors better than Google?The truth about oximetryThe last link is extols a personal bug bear as well - why stab someone's artery to prove nothing? So in the future think twice before an ABG.

Surviving sepsis 2017

Great update on sepsis by JournalWatch. For those who do not have access:


Surviving Sepsis Campaign Updates Guidelines for Management of Sepsis and Septic Shock Daniel M. Lindberg, MD Reviewing Rhodes A et al., Intensive Care Med 2017 Jan 18; This revision of the 2012 guidelines focuses on early management in adults.Sponsoring Organizations: Surviving Sepsis Campaign, Society of Critical Care Medicine, and European Society of Intensive Care MedicineTarget Population: Clinicians who care for adult patients with sepsis and septic shock in a hospital setting. Background and Objective Sepsis remains incompletely understood, imperfectly defined, underrecognized, and exceptionally lethal. The Surviving Sepsis Campaign convened 55 experts from 25 organizations to undertake a systematic review and grading of evidence to update guidelines for the management of sepsis and septic shock in adult patients (NEJM JW Emerg Med Apr 2013 and Crit Care Med 2013; 41:580). This revision was conducted befo…

Vader don't play dat!

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ED rant, 90's Wayans reference and Star Wars all in one vid... how can you go wrong?

CT after CA... worth it?

Here's a good nugget of food for thought from Medscape. We do this too. Outcomes are yet to be viewed though.
SUMMARY AND COMMENT | EMERGENCY MEDICINE January 13, 2017Early Head CT After Cardiac Arrest: One Center's Experience Daniel M. Lindberg, MD Reviewing Reynolds AS et al., Resuscitation 2017 Jan 3; Many computed tomography scans showed abnormalities in this retrospective study, but it's not clear that performing early head CT improved care. Neurological emergencies can result in cardiac arrest, and neurological injury can occur as a result of cardiac arrest. These authors retrospectively assessed the utility of head computed tomography (CT) in patients with out-of-hospital cardiac arrest who survived for at least 24 hours at a single academic center from 2007 to 2015. Of 213 patients in the analysis, 115 (54%) underwent head CT within 24 hours. In 43 patients (20% of all patients; 37% of those who underwent head CT), head CT showed abnormalities, such as loss of gra…

When a lot fails, then what?

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Here's a difficult case that one of our EM residents, Dr Corinne Lau,  encountered. What would you do?73 y/oPMhx:  DM , HTN , HLPresented to the ED for palpitations , non vertiginous giddiness and chest discomfort. \
ECG:

Decision was made for trial of vagal manoeuvres as standby adenosine was being prepared.Post vagal manoeuvres patient became hypotensive . However patient was still alert.ECG repeated showed persistent SVT.IV fluids was given and trial of adenosine was given 6mg–>12mg –>12mg ,However patient reverted back to SVT after a few seconds post adenosine.Repeat BP was  80/60 and patient was still alert.What would you do now?...
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With failure of adenosine , decision  was made for synchronised cardioversion with sedation.50J –>100J–>100J , each time the patient reverted back to SVT within a few seconds and remained hypotensive.Repeat  BP 70/50  despite IV fluids . HR ranged between 180-200.Cardiology on call was consulted:
IV diltiazem (bolus) +…

Sounds better?

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Terrible solar rotation this planet has had. Good to round off the year with something to remind us of the better angels of our nature. Happy 2017 folks!