Acute asthma exacerbations are a common presentation to pediatric emergency departments (EDs). Standard treatment with inhaled beta agonists and corticosteroids are often sufficient in mild asthma but can fall short in the treatment of moderate to severe exacerbations. Magnesium sulfate (MgSO4) has long been touted as an adjunct treatment due to its bronchodilatory properties (both in its intravenous (IV) and nebulized form).
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In patients with an acute respiratory illness (ARI), it is often difficult to determine whether a bacterial infection is the underlying etiology and whether antibiotics are warranted. Excess antibiotic use carries risk of bacterial resistance, medical costs, and adverse drug effects. However, underuse of antibiotics risks inadequate treatment and progression of disease. In the setting of a bacterial infection,
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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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