In 2016 the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), redefined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This group postulated that sepsis can be identified through an increase in Sequential Organ Failure Assessment (SOFA) score of at least 2 points. The quick SOFA (qSOFA) score is a simplified tool that includes respiratory rate >21 breaths/min,
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Atrial fibrillation (AF) is one of the most common dysrhythmias encountered in the ED. The management of recent-onset AF and atrial flutter (AFl) in the ED continues to be debated. The discussion centers on whether patients with recent-onset AF should be rhythm controlled (e.g. converted back to sinus rhythm) or rate controlled only. This debate was showcased in a point-counterpoint in Annals of Emergency Medicine in 2011 (Stiell 2011,
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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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