Core Journal Reviews

Apneic Oxygenation in the ICU

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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Performance of the Ottawa Heart Failure Risk Score

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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Filed Under: Tags: , , March 1st, 2018 Leave a Comment

Angiotensin II for the Treatment of Vasodilatory Shock

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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Effect of US on CPR Pauses in Cardiac Arrest

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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The Ottawa SAH Decision Instrument

Acute headaches account for 1-2% of all ED visits. Of these patients, 1-3% will actually have a subarachnoid hemorrhage (SAH) (Goldstein 2006). This makes it a rare, challenging to make diagnosis but, one with a significant associated mortality. The key for survival in patients with an aneurysmal SAH is recognition followed by prompt endovascular repair or surgery.
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Filed Under: February 8th, 2018 Leave a Comment

Shock Index vs. ABC Score in Predicting Need for Massive Transfusion

Massive hemorrhage is a major cause of early death in trauma patients. A vast majority of US trauma centers haves established Massive Transfusion Protocols (MTP) in order to facilitate early and aggressive balanced resuscitation. Though some institutions have created initiation policies to activate MTP, others rely on subjective clinical judgment based on initial vital signs for activation.
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Filed Under: Tags: , , , February 1st, 2018 Leave a Comment

Topical TXA in Epistaxis

Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 2008, Pallin 2005). Standard anterior epistaxis treatment consists of holding pressure, use of local vasoconstrictors, topical application of silver nitrate and placement of an anterior nasal pack. ED patients with epistaxis often fail conservative management and end up with anterior nasal packs which are uncomfortable.
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Filed Under: Tags: , , , January 25th, 2018 Leave a Comment

Infusion Versus IV Push Low-Dose Ketamine for Analgesia

Sub-dissociative dose ketamine in the ED for treatment of pain is gaining recognition as an adjunct or alternative to opioid analgesics.  Previous research from this group and others have demonstrated a role of low dose ketamine (0.1-0.3 mg/kg IV) as opioid sparing analgesic.The major issue with wider ketamine use is its adverse effects; the feeling of unreality,
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