Tamingthesru
The Thinker
The reality of the Emergency Department is that not everybody is sick, but every patient could be sick. The task of finding the sick patients among the non-sick is far more challenging than it may appear and the diagnostic process is far more fraught with potential sources of error than one would like.
Grand Rounds Recap 7.3.19
Welcome to the new Academic Year! We started the year off with Dr. Pancioli giving us some context of how EM got to where it is and where it is going. Dr Palmer then inspired us to consider our role in the teamwork that is patient care. Dr McDonough then led us in an exercise of delivering bad news to patients, and some of the nuance that is dealing with breadth of reactions to it.
Is the Cath Lab the Place to be after V fib VTac Cardiac Arrest?
Ventricular dysrhythmias are commonly caused by coronary ischemia which is most frequently caused by acute coronary artery occlusions in the setting of coronary artery disease. It would seem somewhat logical that patients who suffer a V fib or V Tach cardiac arrest would benefit from a trip to the cardiac catheterization lab to identify and treat these possible acute coronary artery occlusions. Patient’s with EKGs showing ST-elevations following ROSC already go to the Cath lab. Since the EKG is not terrifically sensitive for MI, should V fib V Tach cardiac arrest patients without ST-elevations make a trip to the Cath lab? In this breakdown of our most recent journal club we look at several papers covering this topic. In the podcast below we also talk with Justin Benoit, MD the site PI for the ongoing ACCESS trial which is also looking into this question.