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 –
Read More
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.
Read More
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.
Read More
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.
Read More
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,
Read More
Since 2000, there have been over 500,000 opioid related overdose deaths in the US. (Burke 2016). Despite the epidemic of opioid deaths, these drugs continue to be used as first line agents for treatment of moderate to severe pain in Emergency Departments (EDs). While demonstration that ED use of an opiate causes future abuse and morbidity/mortality does not exist,
Read More
Cardiac CT Angiography (CCTA) is a promising imaging technique that detects stenosis of the coronary arteries quickly and accurately. It can also detect other causes of chest pain when patients present to the emergency department (ED). Several studies have shown that patients with normal cardiac CCTA results are at low risk for adverse events (Oostema 2012).
Read More