Focused use of ultrasound in resuscitation of patients with shock and cardiac arrest has become increasingly embraced in both the emergency department (ED) as well as in the prehospital setting. Application of ultrasound, particularly of echocardiography, has the potential to identify treatable causes of shock and arrest, identify shockable rhythms and identify the presence of mechanical activity.
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Refractory ventricular fibrillation (VF) is very difficult to manage. Up until recently, emergency providers were limited to defibrillation and delivery of high quality CPR as well as amiodarone administration. However, a couple of recent trials have given us food for thought about two possible additional treatments. The first treatment, dual sequential defibrillation has been investigated in retrospective case series and has shown potential for benefit.
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The evaluation and management of venous thromboembolism (VTE) in the Emergency Department (ED) is fraught with questions: who should I evaluate, who should get a d-dimer, what should the d-dimer threshold be etc. Answers, unfortunately, are far less common. Due to the enormous volume of literature produced on the topic, it can be difficult for individual clinicians to incorporate all of the information into a comprehensive approach.
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This analysis was originally posted on REBEL EM here
Bronchiolitis is an acute inflammatory injury of the distal smaller airways, most commonly caused by viral infections. There have been a host of medications studied in the treatment of bronchiolitis, including steroids, albuterol, epinephrine, and inhaled hypertonic saline, with none proving to be effective in treatment.
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This analysis was originally posted on REBEL EM here
Endotracheal intubation is a common occurrence in the Emergency Department (ED). Many patients requiring airway management are at a higher risk of hypoxia due to deranged respiratory physiology (i.e. decreased functional residual capacity and/or increased shunt fraction). Advocates of VL argue that it provides better visualization of the airway anatomy,
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As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s role in patients with acidemia resulting from or causing arrest is unclear. In theory,
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Skin and soft tissue abscesses are a common emergency department (ED) presentation. The approach to management has changed little in recent decades: incision and drainage (I+D) and then discharge home with follow up. However, increasing rates of methicillin-resistant staph aureus (MRSA) over the last decade have led to further consideration of adjunct therapy with oral antibiotics to improve cure rates.
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This review is cross-posted on REBEL EM.
Alteplase is a tissue plasminogen activator that is approved for use prior to thrombectomy in ischemic strokes with the goal of reperfusion to ischemic areas of the brain. Tenecteplase is a recombinant enzyme derived from alteplase that is more specific to fibrin and more resistant to inactivation by alteplase inhibitors.
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