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The Levy Cup Cometh...
On this day of #EMConf goodness, we tease the upcoming day of Grand Rounds competition known as The Levy Cup. In 3 weeks time, the residents will pair off into teams in a battle of wits and skills. A round robin competition of procedural relay stations, simulations, trivia game shows, Cash for Cases (where the less money you spend on the patient, the more points you get) and some surprises I don't want to spoil here will pair the field down to 2 teams that will compete in the finale. Think SimWars gone crazy!
Oxygen is Good, Methods for Delivery Often are Not
An elderly patient with steroid and oxygen dependent COPD, and NYHA Class IV CHF, presents with dyspnea. The patient is alert but looks somewhat desperate, confused, and exhausted. Exam reveals accessory muscle use, grunting expirations, poor air movement, and cool clammy skin. The patient speaks in two-word phrases. Attempts to improve the situation are made with Lasix, nebulizers, and non-invasive ventilatory support. The patient cannot tolerate BiPAP due to anxiety.
Pericardiocentesis
First, pericardiocentesis should be considered a temporizing procedure. In the setting of trauma, you are hoping that the pericardiocentesis will clear a small amount of blood from the pericardial space and remove any tamponade the might be present. It is likely, however, because of the mechanism of injury, that blood will again rapidly accumulate leading to recurrent tamponade physiology. Ultimately (but not on Air Care — DON’T do a clamshell), these patients will need a pericardial window, exploration, and repair of whatever injury is causing the accumulation of blood.