The Shocked Intubation: Definitive Airway Sans Hypotension

The Shocked Intubation: Definitive Airway Sans Hypotension

Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation.  Yet few words together strike greater fear in the minds of savvy resuscitationists.  Not because we cannot deftly manage shock, or because we are anything but hardy intubators, but because the swiftest way to transform a living patient into a dying patient or a dying patient into a dead patient is to brazenly intubate someone who is in shock.  What are the root causes of endotracheal intubation's (ETI) hemodynamic effects and, most importantly, how do we circumnavigate them?  Read on to learn how to safely intubate the patient in shock…

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Grand Rounds Recap 7.11.18

Grand Rounds Recap 7.11.18

This week’s Grand Rounds started with a leadership session led by Dr. Stettler where we discussed the qualities of strong leaders and how we can use those qualities to implement change within our department and health system. Dr. Knight covered the management of concussions and spinal cord injuries in the emergency department. From there, Dr. LaFollette led us through a discussion of how to manage various ENT and ophthalmology complaints in the community setting.

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Grand Rounds Recap 7.4.18

Grand Rounds Recap 7.4.18

Let the new year begin! This year’s Grand Rounds kicked off with a series of topics covering why what we do matters, and that starts with how we as ED providers conduct ourselves. Dr. Palmer started us off with a discussion of teamwork, how to overcome difficult teamwork scenarios and overcome adverse encounters with integrity. Dr. Doerning gave some insights and lessons in analytics and a foray into datasets using ‘R’ and Dr. McDonough led the group in a talk and small group exercise in professionalism.

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The Last Gasp

The Last Gasp

It is undoubted that effective airway management is a critical link in the care of patients with both in-hospital cardiac arrest and out-of-hospital cardiac arrest.  But how exactly should one manage the airway?  What results in the best outcomes for our patients? Should we be aiming to intubate every patient? Or, are extraglottic devices as effective (or more effective)? What about the good old bag-valve mask?  In our most recent Journal Club we explored the evidence surrounding airway management in cardiac arrest, covering 3 high impact articles.  We also touch on an abstract presented at the 2018 SAEM Academic Assembly which should add significantly to the body of literature when it is published in full.  Take a listen to our recap podcast below and/or read on for the summaries and links to the articles.

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Grand Rounds Recap 6.27.18

Grand Rounds Recap 6.27.18

The final Grand Rounds for the 2017-2018 academic year opened with a fantastic morbidity and mortality conference given by Dr. Ludmer. Dr. Randolph then gave us his approach to the dyspneic and hypoxic patient. Thanks for following us through this enriching and amazing year of education!

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Air Care Orientation Case #4

Air Care Orientation Case #4

May brought the fourth case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack.  This month, a case of sepsis.  Should we just transfer the patient as quickly as possible, or are there other things we should do first?  Read on to find out!

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Grand Rounds Recap 6.20.18

Grand Rounds Recap 6.20.18

This academic year’s penultimate Grand Rounds started with Guest Faculty Lecturer Dr. Richard Levitan lecturing on airway tips, tricks, and trouble shooting. Drs. Harrison, Sabedra, and Summers then led small group sessions focused on unique applications of ultrasound. Dr. Hughes discussed TB management in the ED and Dr. Thompson closed out Grand Rounds with pearls on patient management.

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Grand Rounds Recap 6.13.18

Grand Rounds Recap 6.13.18

In this week’s Grand Rounds, Dr. Polsinelli started us off with the diagnosis and management of aortoenteric fistula. We then discussed burnout and failure in our wellness curriculum in a small group setting, and heard from our colleagues in pharmacy about high-dose insulin therapy for calcium channel and beta blocker overdose. Dr. Roche led us in our Mastering Minor Care curriculum with a discussion of all things arthrocentesis, and we closed with a great combined PEM/EM simulation session and oral boards practice.

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AirCare Series: Pre-Hospital Ultrasound

AirCare Series: Pre-Hospital Ultrasound

This month's AirCare Series post is the first podcast in the series!  In this podcast one of our current interns, Adam Gottula, interviews a graduate of our program, Andrew Latimer.  Dr. Latimer is currently a Senior EMS Fellow at the University of Washington.  In this interview, Dr. Latimer discusses how they use pre-hospital ultrasound at his flight program as well as his thoughts on the future applications of this technology. 

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Grand Rounds Recap 6.6.18

Grand Rounds Recap 6.6.18

This week we were led through the evaluation and management of the difficult pediatric airway with Dr. Carleton in our quarterly airway grand rounds, and discussed cranial nerve abnormalities with Dr. Neel in our recurring EM-neuro combined conference. Dr. Jarrell presented an interesting case of a child with a cough and weight loss, and Dr. Jensen walked us through the clinical utility of BNP. Finally, Dr. Miller presented an interesting case of a patient with multisystem organ failure and cecum perforation. 

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Grand Rounds Recap 5.30.18

Grand Rounds Recap 5.30.18

This week’s Grand Rounds started with Dr. Gorder’s expertly delivered Morbidity and Mortality lecture. Dr. Gottula then went over drugs of abuse, including the gabapentinoids. Dr. Shaw then talked about a case of sympathetic acute crashing pulmonary edema (SCAPE). Finally, Dr. Edmunds spoke about pediatric renal emergencies.

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Whole Blood - More than the Sum of Its Components?

Whole Blood - More than the Sum of Its Components?

Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?  

A: If they've lost blood, give them blood.  

It's never quite that simple though right?  For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components.  Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients.  Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy.  If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?

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