Greg Kelly drills down to bring us the basics of looking after sick neonates.
So SHOCK IT!…..Survival Rate: OHCA 12%/IHCA 24.8
Enters Dual Sequential Defibrillation (DSD)
Now onto the humans…
|Author||Type of Research||Outcomes|
|1. Lybeck et al. 2015||Case Report||Pt survived after DSD on 8th attempt|
|2. Cabanas et al. 2014||Case Series||ROSC in 7 of 10 patients. No Survivors|
|3. Hoch et al. 1994||Subgroup Analysis||5 patients converted in EP lab after refractory VF. All survived|
|4. Leacock 20147||Case Report||Pt survived after DSD on 5th attempt (400J)|
|5. Gerstein et al. 2014||Case Report||Pt had ROSC after 400J with DSD and failed single multiple defibs. Pt did not survive|
HOW TO DELIVER DSD:
Johnston et al 2016 Case Report: For the romantics
28yo F presents with out of hospital cardiac arrest as witnessed by husband. Husband calls 911 and begins CPR while awaiting for EMS. 6 minutes later EMS arrives and begins ACLS. Within first 15 minutes patient receives 6 shocks, Epi, Amio and then last but not least double sequential defibrillation and achieves ROSC 2 minutes later! EKG is STEMI negative. Patient taken to hospital later diagnosed with long QT syndrome, gets an ICD, and leaves hospital with significant level of independent function and able to return to her 16mo old daughter!!
Shoutout to Doug for posting this topic for a previous TR Pearl and bringing it to my attention!
25th Anniversary The Poison Review Podcast: Wild, Wacky and Weird Toxicology Articles From The Last Quarter-Century
“It is universally well known, that in ingesting our common food, there is created or produced in the bowels of human creatures, a great quantity of wind.” Benjamin Franklin
Stool osmolar gap = 290 – 2*(stool Na + stool K) [normal 50-100 mOsm/kg]
If stool osmolar gap < 50, diarrhea is secretory
If stool osmolar gap > 100, diarrhea is osmotic
Osmotic diarrhea will resolve with fasting; secretory diarrhea will not
Here is a link to a stool osmolar gap calculator
To read WebMD’s discussion of cases similar to that of the airline stewardess,
NOTE: As indicated above, current thinking is that a normal stool osmolar gap is
between 50 and 100 mOsm/kg. Interestingly, by that measure the stool
osmolar gap in this case of the air stewardess with puzzling diarrhea was
Other items discussed on the podcast:
Your Own Perfect Medicine (book)
To read my “Toxicology Rounds” column on autourotherapy, click here
Quizzler (Podcast #11): In James Joyce’s novel Ulysses, Leopold Bloom’s father had committed suicide by self-poisoning. The Quizzler: what agent did Rudolph Bloom (né Rudolph Virág) use to kill himself? The answer: aconite. The winner, Dr. Richard Hamilton of Philadelphia, received a TPR t-shirt. Congratulations to Dr. Hamilton!
This episode’s Quizzler is at the end of the podcast. The winner will receive a $10 Amazon gift certificate as well as the TPR t-shirt. Our rules have changed slightly. Rather than awarding the prize to the first correct answer, we will take all correct answers submitted before the deadline and randomly select a winner. The deadline for submission is October 11, 2016, 6 pm (Chicago time.) Send submissions to: firstname.lastname@example.org. Good luck!
The post TPR Podcast Episode #12: 25 years of weird and wacky toxicology papers appeared first on FOAM EM RSS.
Damage control surgery for trauma is over 20 years old, yet we continue to find ways to refine it and make it better. Many lives have been saved over the years, but we’ve also discovered new questions. How soon should the patient go back for definitive closure? What is the optimal closure technique? What if it still won’t close?
One other troublesome issue surfaced as well. We discovered that it is entirely possible to leave things behind. Retained foreign bodies are the bane of any surgeon, and many, many systems are in place to avoid them. However, many of these processes are not possible in emergent trauma surgery. Preop instrument counts cannot be done. Handfuls of uncounted sponges may be packed into the wound.
I was only able to find one paper describing how often things are left behind in damage control surgery (see reference below), and it was uncommon in this single center study (3 cases out of about 2500 patients). However, it can be catastrophic, causing sepsis, physical damage to adjacent organs, and the risk of performing an additional operation in a sick trauma patient.
So what can we do to reduce the risk, hopefully to zero? Here are my recommendations:
Tomorrow, a sample damage control closure x-ray.
Reference: Retained foreign bodies after emergent trauma surgery: incidence after 2526 cavitary explorations. Am Surg 73(10):1031-1034, 2007.
This episode of CRACKCast covers Rosen’s Chapter 042, Facial Trauma. Continuing in our series on all things trauma, this episode tackles the issue of facial trauma and explores some of the nuances in the diagnosis and management of these patients. Shownotes – PDF Link Rosen’s in Perspective mechanism of facial trauma varies significantly age highly associated with alcohol use 49% of maxillofacial trauma was ETOH related in one study (many from assaults) other …
Welcome to the Toxicology (Part 1) AIR-Pro Module. Below we have listed our selection of the 10 highest quality blog posts related to 5 advanced level questions on toxocology topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:
In this module, we have 6 AIR-Pro’s and 4 Honorable Mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net and FOAMSearcher.We have a brand new chief resident team and want to thank the out-going team for all of their support!
In an effort to truly emphasize the highest quality posts, we have 2 subsets of recommended resources. The AIR-Pro stamp of approval will only be given to posts scoring above a strict scoring cut-off of ≥28 points (out of 35 total), based on our AIR-Pro scoring instrument, which is slightly different from our original AIR Series scoring instrument. The other subset is for “Honorable Mention” posts. These posts have been flagged by and agreed upon by AIR-Pro Board members as worthwhile, accurate, unbiased and useful to senior residents. Only the posts with the AIR-Pro stamp of approval will be part of the quiz needed to obtain III credit. To decrease the repetitive nature of posts relating to these advanced concepts, we did not always include every post found that met the score of ≥28 points.
ALiEMU AIR-Pro Toxicology block quiz
(You will need to create a one-time login account if you haven’t already.)
3 hours (20 minutes per article, 30 minutes for articles with podcasts)
|EMPharmD: Flumazenil: Friend or Foe?||Nadia Awad||Nov 7, 2013||AIR-PRO|
|ALiEM: Utility of Pre-4-Hour Acetaminophen Levels in Acute Overdose||Bryan Hayes||Aug 5, 2015||AIR-PRO|
|StEmlyns: Opiate Overdose in the ED||Simon Carley||Feb 27, 2015||AIR-PRO|
|EMJClub: Treat and Release vs Observation After Naloxone for Opioid Overdose||EMJ Club||Nov 24, 2014||AIR-PRO|
|LIFTL: Liver Transplantation for Paracetamol Toxicity||Chris Nickson||April 30, 2016||AIR-PRO|
|ALiEM: 5 Tips in Managing Acute Salicylate Poisoning||Kristin Fontes||Nov 4, 2013||AIR-PRO|
|LITFL: Paracetamol/Acetaminophen Overdose||Chris Nickson||Sept 3, 2010||Honorable Mention|
|ALiEM: Tricks of the Trade: Naloxone Dilution for Opioid Overdose||Bryan Hayes||Nov 17, 2014||Honorable Mention|
|LITFL: Paracetamol||Chris Nickson||2015||Honorable Mention|
|EMDocs: Pearls and Pitfalls of Salicylate Toxicity in the ED||Samantha Berman & Josh Bucher||Oct 13, 2015||Honorable Mention|
“Rather than love, than money, than fame, give me truth.” -Thoreau The Case A 56 year old man with non-ischemic cardiomyopathy [LVEF 40% and mitral regurgitation] is admitted with severe sepsis due to appendicitis. One month prior to admission, his outpatient cardiologist saw him and noted a dry weight of 88 kg. On admission to the [… read more]
The post Sepsis-Associated AKI – Bellomo Kidney – Implications for Management appeared first on PulmCCM.
Not only do we have to battle with diagnostic uncertainty, a high intensity and stressful environment but we also have to contend with our own minds and the tricks and biases they play on us. As if things weren’t hard…