In critically ill patients, fluid status is a balancing act. Too little fluid resuscitation can lead to end organ hypoperfusion, while too much fluid resuscitation can lead to pulmonary edema and respiratory compromise. In some situations, it is difficult to differentiate who will benefit from more fluids and who will be fluid unresponsive or even require fluid restriction.
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Journal Review
Ultrasound Guided Fluid Assessment Protocol
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Compartment Syndrome
Compartment syndrome is a limb and life threatening disease where rapid recognition, diagnosis and aggressive management is critical.
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Journal Review
Intravascular Complications of Central Line by Insertion Site
Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for complications including infection, thrombosis and mechanical dysfunction (pneumothorax, hematoma). The authors’ previous research led them to believe that these complications will differ according to the site of insertion.
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Acromioclavicular (AC) Joint Injuries
AC joint injuries are commonly encountered in upper extremity injuries. This post reviews physical exam, x-ray findings and management.
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Journal Review
REVERT – The Modified Valsalva Maneuver
Supraventricular tachycardias (SVT) (excluding atrial fibrillation and atrial flutter) are common cardiac arrhythmias leading to presentation to the Emergency Department (ED). The Valsava maneuver is a recommended first-line method to cardiovert stable patients, but its reported efficacy is low (5-20%). Chemical cardioversion agents can have unpleasant side effects and require intravenous access. Increasing the success rate from the Valsava maneuver could lead to increased patient comfort and decreased resource utilization.
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Apparent Life-Threatening Event (ALTE)
ALTEs are relatively common presentations requiring thorough assessment and careful consideration for disposition.
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Journal Review
Ketamine vs. Morphine in Acute Pain Management
Ketamine, a noncompetitive N-methyl-D-asparate and glutamate receptor antagonist, is a Phencyclidine-like dissociative agent that possesses potent analgesic, anxiolytic and amnestic properties. In the Emergency Department (ED), ketamine is commonly used for procedural sedation. Outside of the ED, subdissociative doses (0.3 mg/kg), have been successfully used as an adjunct to opiate refractory pain. Recent data has shown that subdissociative doses of ketamine may be comparable to morphine as a first-line agent in out-of-hospital settings.
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