Intravenous (IV) nitroglycerin (NTG) infusion is one of the mainstay treatments in acute pulmonary edema (aka acute decompensated heart failure (ADHF)), but is associated with increased hospital length of stay (LOS) and health care costs. Optimal NTG dosing isn’t established though physiologically, higher infusion doses (> 100 mcg/min) are helpful as they affect both afterload and preload.
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This post is cross-posted on REBEL EM here.
Thanks to Salim Rezaie for his edits.
Intraosseous (IO) access can play an important role in the resuscitation of the critically ill patient to help expedite delivery of critical medications (i.e. RSI). Much like with peripheral or central access, obesity can present a challenge to placement of an IO as accurate placement relies on use of landmarks which may not be palpable in this group.
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The ability to perform procedural sedation and analgesia (PSA) is essential to the practice of Emergency Medicine (EM). Which agent an Emergency Provider chooses to use depends on a variety of factors, including provider comfort and preference, ease of access and, most importantly, perceived safety of the medications.
Propofol and Ketamine are two commonly used agents for PSA,
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Thanks to Salim Rezaie for guest editing this post which is cross-posted on REBEL EM.
Ketorolac is a commonly used parenteral analgesic in the Emergency Department (ED) for a variety of indications ranging from musculoskeletal injuries to renal colic. This non steroidal anti-inflammatory drug (NSAID) is available in oral, intranasal and parenteral routes.
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Special thank you to Salim Rezaie for guest editing this post.
Out-of-hospital cardiac arrest (OHCA) affects > 300,000 people in the US each year and most of these patients are transported to the Emergency Department (ED) for further care. Currently, survival to discharge sits at around 8%. Over the last decade, it has become clear that the keys to improved return of spontaneous circulation (ROSC) and return of neurologic function (RONF) are early CPR,
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Cardiac arrest is common occurrence effecting > 300,000 Americans each year and with a generally dismal prognosis (survival rate 7-9%). Currently, there is an absence of evidence or guidelines to aid physicians’ regarding the timing of resuscitation termination when patients do not obtain return of spontaneous circulation (ROSC). Point-of-care ultrasound (POCUS) has been useful in other critical patients such as in trauma or undifferentiated shock.
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Thanks to Rory Spiegel for providing peer review for this post.
This post is cross-posted on REBEL EM.
Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain.
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