Cardiac arrest remains associated with very high morbidity and mortality, and neurologically meaningful recovery (the most important goal of cardiac arrest care) is a regrettably infrequent outcome despite the best efforts of providers. Resuscitative efforts in cardiac arrest patients typically center around ACLS algorithms and attempts to find and correct reversible causes of clinical decompensation,
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In patients with symptoms of pulmonary embolism (PE), we often turn to vital signs, including heart rate, respiratory rate and pulse oximetry, as part of our initial impression of the patient. Before even considering further testing, such as d-dimer or CTPA, we look first at the vital signs to form our gestalt impression of the patient.
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Iatrogenesis is an adverse patient condition directly resulting from medical treatment or error, occurring in nearly 4% of hospitalizations with 50% being preventable and 14% resulting in death (Berwick 1999, Brennan 2000). What is even more concerning is that studies have suggested that this rate is higher in pediatric patients. Research has focused primarily on patient-related factors like age and weight,
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Although many patients visit Emergency Departments (EDs) for hyperglycemia, there is no consensus on optimal care prior to discharge. Most of these patients present with moderate elevations of serum glucose without severe manifestations (i.e. diabetic ketoacidosis, hyperosmolar hyperglycemic state). The risk of discharging patients with an elevated glucose level is unknown.
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It has been recognized since the 1940s that the presence of a Left Bundle Branch Block (LBBB) obscures the EKG diagnosis of myocardial infarction (MI). The publication of the Sgarbossa criteria in 1996 aided in clarifying this issue.
Sgarbossa Criteria (Sgarbossa 1996)
However, these criteria are not perfect. The original,
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The current ACLS guidelines give both procainamide and amiodarone a class II recommendation as chemical therapy for the treatment of patients with stable ventricular tachycardia. Despite the fact that one drug does not appear to have an advantage over the other based on available literature, amiodarone appears to be agent preferred by intensivists, cardiologists and Emergency Physicians alike.
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Total body CT scanning is increasingly being utilized as part of the initial survey of trauma patients in trauma centers. The belief is that initial total body scan provides a comprehensive evaluation of life threatening traumatic injuries, requires fewer trips to the CT scanner, and mitigates the necessity for other imaging modalities such as x-ray and ultrasound.
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