Pneumonia, an acute infection of the pulmonary parenchyma, is a disease that commonly presents to US Emergency Departments, with an incidence as high as 9.7 per 1000 persons in developed countries. Studies have found that community acquired pneumonia alone has a hospitalization rate of 46.5% and 30-day mortality of 12.9%, with a case fatality rate of over 50% in patients with pneumonia-related sepsis/septic shock (Kolditz 2016,
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Dabigatran is an oral direct thrombin inhibitor, touted as non-inferior to Warfarin (though there is some debate about its safety (Yao, Abraham et al. 2016, Hernandez, Baik et al. 2018). It is now routinely prescribed for the treatment of non-valvular atrial fibrillation, venous thromboembolism (VTE) and post-surgical prophylaxis. Dabigatran blocks the last stages of the coagulation cascade,
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This Journal Review is cross-posted on REBEL EM.
Placement of vascular access for administration of resuscitation drugs and fluids is a common procedure in the management of out of hospital cardiac arrest (OHCA). While intravenous (IV) placement has been the standard approach for decades, intraosseous (IO) access is rapid and safe and may be the preferred approach due to fact that the bone marrow does not collapse during shock states as peripheral veins often do.
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Hypoxemia is the most common complication of endotracheal intubation in the critically ill and the strongest risk factor for periprocedural cardiac arrest and death. The traditional approach to avoiding desaturation during intubation is preoxygenation. However, in critically ill patients, acute physiologic abnormalities render preoxygenation less effective. Apneic oxygenation is the delivery of supplemental oxygen to the nasopharynx in the absence of ventilation.
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In the United States, heart failure affects 5.7 million people. Acute heart failure exacerbation is a common ED presentation and 1 in 9 deaths in the US included heart failure as a contributing cause. Each year it contributes to more than 1 million hospitalizations, and while in the past almost all patients with acute heart failure exacerbations were admitted,
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ICU patients with vasodilatory shock continue to have a high mortality despite advancements in treatment. Maintaining blood pressure, and thus organ perfusion, is one key in management. Decreases in mean arterial pressure (MAP) can have serious complications including damage to the kidneys, heart, and brain. The human body has 3 sources of natural vasopressors –
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The provision of high-quality compressions with minimal interruptions is central to the management of cardiac arrest. Along with defibrillation, high-quality compressions are the only interventions proven to improve patient-oriented outcomes. Recently, point-of-care ultrasound (POCUS) has gained greater use in cardiac arrest care for determination the cause of arrest as well as guiding the resuscitation and interventions.
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