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SOBRE EL AUTOR **

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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

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sábado, 24 de junio de 2017

Bilateral leg edema

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emDocs - June 19, 2017 - Authors: Weymouth W and Ong D
Edited by: Koyfman A and Long B
"Take Home Points
  • Major organ systems involved with peripheral edema include the heart, kidneys, and liver.
  • History and exam are the most important aspects of the evaluation of lower extremity edema.
  • Look for signs of cirrhosis and ascites. If ascites is present, obtain LFTs and perform paracentesis.
  • Consider a BNP or bedside ultrasound (if clinically indicated), BMP, and a UA to evaluate for heart failure and nephrotic syndrome.
  • Consider other tests as indicated (i.e. history of malignancy-DVT ultrasound, woman of childbearing age-pregnancy test, etc.)"

Incidente terrorista

Semes Divulgación logo
junio 23, 2017 
"Si te ves involucrado en un incidente terrorista, sigue los consejos que te ofrecemos desde #DivulgaSEMES y el Grupo de Enfermería Militar de SEMES"

Knowledge Translation Recommendations

An online community of practice for Canadian EM physicians
CanadiEM - June 3, 2017 - By Brent Thoma
"As part of the 2017 Canadian Association of Emergency Physicians (CAEP) Conference an Academic Symposium was held on research. One aspect of this symposium investigated best practices for knowledge translation in the emergency department. The 10 recommendations presented in the above infographic and following below were compiled using the preliminary results of a systematic review that was conducted on this topic along with the results of a national survey of emergency physicians. In addition to seeking the input of the symposium participants, we hope to receive additional feedback from the virtual community of emergency physicians and practitioners online. We would appreciate your feedback. All responses will be analyzed and incorporated to improve the final recommendations."


jueves, 22 de junio de 2017

Whole Body CT vs. Selective Imaging in Trauma

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emDocs - Jun 21, 2017 - Authors: Long B & & April M - Edited by: Koyfman A
"Recommendations
  • There are protocols determining need for WBCT in trauma. Most of these take into account mechanism of injury, patient injuries, hemodynamic status, and other studies such as labs and FAST scan, with recommendation to obtain WBCT in patients with abnormal mental status, hemodynamic instability, and suspicion of critical injury.30,65-67
  • Ultimately, the physician should go through their trauma ABC’s and conduct a history and exam. US should be a component of this exam. Patients with concern for severe polytrauma or those who are not clinically evaluable may benefit from WBCT. At this point, in patients who are evaluable with no evidence of polytrauma, selective imaging based on history and exam is recommended."

miércoles, 21 de junio de 2017

Falls in Elderly

EM Didactic - By Rishal Rahman - June 19, 2017
"Definition
An event that leads to a conscious subject unintentionally coming to rest on ground or a lower level, not as a result of a overwhelming hazards or a major intrinsic event. e.g. – not due to trauma, seizure or syncope. A recurrent fall is defined as 2 or more falls occurring within 6 months, which need extensive evaluation for etiology...

Take home
  • During all the stages of working up, ask yourself - what could have precipitated this fall? Spend more time on history (next of kin, nursing home, paramedics)
  • Have a low threshold for admitting elderly with unexplained events
  • Keep the thought process broad with all differentials and causes in mind
  • Some times you may not be able to get that answer, that's okay – make sure you are not missing any thing gross."

IV Lipid emulsion for drug toxicity

CanadiEM - By Jared Baylis - June 20, 2017
"Summary
  • Lipid emulsion therapy has provided an exciting avenue of therapy with potential survival benefit in severe drug toxicity
  • Most of the evidence is from case reports which are subject to several biases including positive reporting bias
  • The ASRA guidelines provide the most agreed upon guidance for dosage (100mL 20% lipid emulsion bolus followed by 18mL/min infusion for 30 mins)
  • Consider lipid emulsion therapy in patients presenting with refractory cardiovascular collapse secondary to drug toxicity where the offending agent is lipophilic and there are no further viable options for treatment
  • Adverse effects are rare if your infusion rate is less than 0.55 mL/kg/min and your daily dose is less than 10mL/kg"

lunes, 19 de junio de 2017

Paramedian Approach to LP

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ACEP Now - By Crespo M and Jones R  - June 13, 2017 
Figure 1: Posterior view of the lumbar spine.
..."An alternative method to the traditional lumbar puncture is the paramedian approach. Although scarce in the emergency medicine literature, it has been a successful option that has been performed by anesthesiologists for decades. Advantages of this approach include a larger target through the interlaminar space as well as avoidance of the supraspinous and interspinous ligaments. The paramedian approach allows for faster catheter insertion, fewer attempts at needle insertion, and a lower incidence of post lumbar puncture headache. This approach can be performed in the neutral spine position. The paramedian approach is associated with fewer technical problems compared to the midline approach, and because it avoids the supraspinous and interspinous ligaments, the procedure is less painful and ideal in elderly patients with calcified ligaments. This approach penetrates the ligamentum flavum directly after passing through the paraspinal muscles. First-attempt success rates with the paramedian approach have been reported to be 30 percent to 40 percent higher when compared to the midline approach..."

Submassive PE

TAMING THE SRU

Taming The SRU - June 15, 2017

"Last week our Journal Club focused on the treatment of hemodynamically significant pulmonary emboli. These are pulmonary emboli causing either frank hypotension (sometimes called massive or high risk PEs) or causing significant right heart strain as evidenced by CT findings, cardiac biomarker elevation, or bedside Echo findings. Drs. Grace Lagasse, Kari Gorder, and Claire O'Brien led us in a discussion of the 3 papers linked and explained below. Read the papers yourself, listen to the podcast, read the summaries and get caught up on all things PE..."

viernes, 16 de junio de 2017

Alternative Headache Therapies

R.E.B.E.L.EM - June 15, 2017 - By Rick Pescatore
"Clinical Bottom Line:
In selected patient populations, alternative therapies such as sphenopalatine ganglion block, paraspinous cervical nerve block, and low-dose propofol therapy offer additional and potentially effective opioid sparing modalities for the patient presenting with acute primary headache. Additional data are needed to investigate the efficacy of these techniques, however they appear to be safe and well-tolerated."

jueves, 15 de junio de 2017

Antibiotic Choice in Uncomplicated Cellulitis

R.E.B.E.L.EM - June 8, 2017 - By Anand Swaminathan
Post Peer Reviewed by Salim Rezaie
"Background:
Cellulitis is a common emergency department (ED) presentation. Despite the fact that diagnosis remains relatively straight forward, complexity remains in management in terms of the causative agent and appropriate antibiotic regimen. Though beta-hemolytic Streptococci are the most common causative agents there is increasing prevalence of community acquired methicillin-resistant Staphylococcus aureus (MRSA). Cephalexin has long been used to treat uncomplicated cellulitis because of it’s activity against streptococci and methicillin-sensitive S. aureus (MSSA). Despite the current Infectious Disease Society of America (IDSA) recommendations against routine coverage of MRSA, trimethoprim-sulfamethoxazole (TMP-SMX) is often added to cephalexin (Stephens 2014). While there are other single options for coverage, they either have suboptimal MRSA coverage (i.e. clindamycin and doxycycline) or are more expensive (i.e. linezolid). Without reliable ways to determine which patients need MRSA coverage, it is unclear which patients with uncomplicated cellulitis need to be discharged with MRSA coverage and which will do fine with a single agent..."

Appendicitis Mimics

emDocs - June 14, 2017 - Author: Chase C - Edited by: Koyfman A & Long B 
"Summary:
  • Abdominal pain is a common and high-risk ED complaint. Appendicitis and its mimics are often indistinguishable in their presentation.
  • Appendicitis mimics requiring consideration include: ectopic pregnancy, ovarian/testicular torsion, pelvic inflammatory disease/TOA, terminal ileitis, cecal diverticulitis, cecal volvulus, gastroduodenal perforation, intussusception, Crohn’s Disease, ureterolithiasis, cholecystitis, etc.
  • Every reproductive-aged female should have a pregnancy test, and males should have testicular exam when presenting with lower abdominal pain.
  • Epiploic appendagitis, omental infarction, and mesenteric adenitis seen on CT are typically benign, self-limited disease processes.
  • Early surgical consultation required if suspecting: ruptured ectopic, testicular/ovarian torsion, ruptured TOA, cecal volvulus, gastroduodenal perforation, adult intussusception, cholecystitis, or toxic megacolon."

martes, 13 de junio de 2017

Platelet for ICH (PATCH)

The Skeptics Guide to Emergency Medicine
SGEM#182 - June 5, 2017 - By Robert Edmonds
..."Clinical Question: Does platelet transfusion reduce death or dependency in acute hemorrhagic stroke for patients on antiplatelet agents?
SGEM Bottom Line: There appears to be evidence of harm if platelet transfusion is given to reverse antiplatelet agents in patients with atraumatic intracerebral hemorrhage, so this practice cannot be recommended..."

Amiodarone

R.E.B.E.L.EM - June 12, 2017 - By Anand Swaminathan 
Post Peer Reviewed By: Mallemat H & and Rezaie S
..."This post dives into the three most common places amiodarone is employed in the ED: cardioverion of atrial fibrillation, cardioversion of VT and in refractory VF/VT cardiac arrest and demonstrates that superior evidence points to better options for management...
ClinicalBottom Line:
There is a danger in summarizing a complicated topic with a one liner but, in regards to amiodarone, the best available evidence does not show any clear benefit for any of the major indications for ED use. However, the drug does have proven harms (i.e. hypo/hyperthyroidism, pulmonary toxicity, acute liver disorders). Given that we have better options for stable AF and VT cardioversion and that we have more important interventions to focus on in cardiac arrest, amiodarone should not be routinely used for any of these indications."

Sedation errors in the ED

emDocs - May 11, 2017 - Authors: Vetter N & Sturm J -  Edited by: Robertson J Koyfman A
..."Procedural sedation and analgesia (PSA) is a core skill set of the emergency physician (EP). It improves patient satisfaction by providing amnesia, anxiolysis and analgesia. Sedation also makes our consultants happier as it facilitates an easier and faster procedure.
However, studies show that EPs inadequately treat pain in the emergency department (ED) for multiple reasons:
  • Fear of over-sedation
  • Fear of adverse events
  • Inadequate knowledge
  • Inadequate dosing
  • Insufficient time
  • Insufficient resources

miércoles, 7 de junio de 2017

WHO new classification of ATB

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Reuters Health News - June 07, 2017
"The World Health Organization published a new classification of antibiotics on Tuesday that aims to fight drug resistance, with penicillin–type drugs recommended as the first line of defense and others only for use when absolutely necessary.The new "essential medicines list" includes 39 antibiotics for 21 common syndromes, categorized into three groups: "Access," "Watch" and "Reserve."Drugs on the "Access" list have lower resistance potential and include the widely–used amoxicillin.The "Watch" list includes ciprofloxacin, which is commonly prescribed for cystitis and strep throat but "not that effective," WHO Assistant Director–General for Health Systems and Innovation Marie–Paule Kieny told reporters.Its use should be "dramatically reduced," the WHO said."We think that the political will is there but this needs to be followed by strong policies," Kieny said.In the "Reserve" category antibiotics such as colistin should be seen as a last resort. That prompts questions about how producers of such antibiotics could make money, said Suzanne Hill, WHO's Director of Essential Medicines and Health Products."What we need to do is stop paying for antibiotics based on how many times they are prescribed, to discourage use. We don't want colistin used very frequently. In fact we don't want it used at all," Hill said."What we need to do as a global community is work out how we pay the company not to market colistin and not to promote it and to keep it in reserve..."

martes, 6 de junio de 2017

Albumin for SBP

R.E.B.E.L.EM - Jun 5, 2017
The Guidelines:
The 2012 AASLD Guidelines, based largely on the trial by Sort, et al., recommend that patients with ascitic fluid PMN counts greater than or equal to 250 cells/mm3 and clinical suspicion of SBP, who also have a serum creatinine >1 mg/dL, blood urea nitrogen >30 mg/dL, or total bilirubin >4 mg/dL should receive IV albumin (1.5 g/kg) within 6 hours of detection and 1.0 g/kg on day 3. (Class IIa, Level B)i
The Takeaway:
The use of IV albumin in addition to antibiotics in the treatment of patients with SBP and concomitant azotemia or hyperbilirubinemia is a lifesaving intervention of critical importance in the emergency department. As the published data and AASLD recommend administration within six hours of diagnosis, this intervention falls firmly in the hands of ED providers.
The Recommendation:
We recommend timely administration of 1.5 g/kg of albumin in addition to antibiotics in all patients presenting to the emergency department diagnosed with SBP who also have a serum creatinine >1 mg/dL, BUN >30 mg/dL, or total bilirubin >4 mg/dL.

Insuficiencia cardiaca crónica

Inicio
"Esta Guía de Práctica Clínica, orientada exclusivamente a la insuficiencia cardiaca crónica, responde a 10 preguntas clínicas identificadas entre aquellos aspectos no tratados o sin resolver en guías recientes, siendo conscientes de que acotar el alcance puede implicar que algún aspecto importante no haya quedado incluido. Entre los temas abordados, se encuentra el tratamiento farmacológico en pacientes mayores de 65 años con disfunción sistólica, en pacientes con fracción de eyección preservada o ligeramente deprimida. Así mismo se plantean aspectos del tratamiento no farmacológico como el control temprano tras el alta hospitalaria, las medidas higiénico dietéticas, la monitorización mediante péptidos natriuréticos para control de tratamiento farmacológico, los programas de telemedicina, la de la rehabilitación cardiaca basada en el ejercicio y la de los desfibriladores automáticos implantables en mayores de 65 años. 
Esta guía es el resultado del gran esfuerzo realizado por un grupo de profesionales sanitarios pertenecientes a distintas especialidades y sociedades científicas, y representantes de varias Sociedades Científicas implicadas en esta enfermedad. Entre ellos se encuentra el Dr. Luis Manzano Espinosa, del Grupo FEMI de Insuficiencia Cardiaca y Fibrilación Auricular."
Año de publicación: 
2017

lunes, 5 de junio de 2017

Analgesic for critically ill patients

PulmCrit (EM Crit)
PulmCrit - June 5, 2017 - By Josh Farkas
"We all want to alleviate pain and suffering. Most critically ill patients are treated with opioids for this reason. Unfortunately, opioids have numerous side-effects including delirium, constipation, vomiting, and delayed extubation. Opioid infusions may eventually lead to withdrawal, causing pain, nausea, and depression. This post explores the optimal use of systemic medications to control pain while minimizing complications (1)..."

Heart Failure Scale

Resultado de imagen de emergency medicine news

Sorelle, Ruth - Emergency Medicine News 2017; 39 (6): - 29–29 
doi: 10.1097/01.EEM.0000520575.56556.d4 
"Emergency physicians have historically lacked validated tools for determining which patients with shortness of breath associated with acute heart failure should be admitted and which could be safely discharged. Now, a clinical decision tool may provide a map of the best course to take. 
Arising from the distinguished Ottawa Hospital Research Institute, the Ottawa Heart Failure Risk Scale was validated in a study recently reported in Academic Emergency Medicine. (2017;24[3]:316.) Starting with 40 different criteria, Ian Stiell, MD, MSc, a senior scientist in clinical epidemiology at the Ottawa Hospital Research Institute, and his colleagues ended up with a scale of 10 items. They applied the risk scale to 1,100 patients (average age, 77.7) seen in the emergency departments of six tertiary hospitals to validate it..."

domingo, 4 de junio de 2017

The Standardized Video Interview

CORD EM - June 01, 2017 - Author: Ashley Rider, MD, EM Resident, Highland Emergency Medicine, on behalf of the CORD Student Advising Task Force
Screen Shot 2017-06-01 at 7.15.07 AM
"This application season, Emergency Medicine will be the first specialty to pilot the Standardized Video Interview (SVI). Last year the Association of American Medical Colleges (AAMC) performed an assessment of the tool among a small cohort across multiple specialties to demonstrate validity and reliability. Now it’s prime time..."

Recomendaciones SEMICYUC

urgenciasdeponiente - 03/06/2017
"La SEMICYUC presenta la iniciativa 5 Recomendaciones;
En base a la evidencia científica disponible, cada Grupo de Trabajo de la SEMICYUC, ha planteado las 5 actuaciones que han sido consideradas mas relevantes sobre su área.
Descargarse las recomendaciones:
Individuales PDF.
Compacto PDF."

miércoles, 31 de mayo de 2017

Pelvic fractures

emDocs - May 29, 2017 - Authors: Lupez K -  Edited by: Koyfman A and Long B
"Case
A 50-year-old male presents to the ED via EMS after being a restrained driver in a head on high speed MVC. He is currently hemodynamically unstable with a BP of 87/45 and HR of 130. On primary survey, airway is intact, breath sounds are equal bilaterally, there is no obvious external hemorrhage, and his GCS is 15. Secondary survey is notable for a soft and non-tender abdomen, no extremity deformities, and no shortening or rotation noted on bilateral lower extremity exam. However, pain is elicited and instability is noted on gentle downward and medial compression of the pelvis over the iliac wings..."

iSepsis

EMCrit - May 27, 2017 - By Paul Marik
"The Goal of this Website.
The goal of the Website is to provide clinicians useful, evidence-based information regarding sepsis and its management. We will not perpetuate the mistruths and unscientific information generated by the Early Goal Directed study and propagated by the Surviving Sepsis Campaign [2-5] and other affiliated organizations. This website will be devoid of commercial, financial and other conflicts of interest.
Our goal is to:
Inform, generate Inquiry with open discussion and to do this with Integrity and honesty..."

sábado, 27 de mayo de 2017

Erythrocytosis

emDocs - May 24, 2017 - Author: Jeffers K - Edited by: Koyfman A and Long B
"Summary:
  • Consult hematology early for recommendations, further evaluation, and definitive treatment.
  • Secondary erythrocytosis is from numerous causes; a good history and physical will discover most of them! EPO level may be helpful for differentiation.
  • Treatment of secondary erythrocytosis includes removal of offending cause and possibly phlebotomy.
  • Consider PV in setting of elevated hemoglobin/hematocrit + symptoms (pruritus, headache, fatigue, difficulty thinking or sleeping, dizziness, hyperuricemia, and bleeding or thrombotic complications) especially in persons >60 years old.
  • Initial treatment of PV includes phlebotomy (consult your specialist) and low-dose aspirin.
  • Hyperviscosity syndrome: triad of bleeding, visual disturbances, and focal neurologic signs. Mainstay of treatment is hydration and hematology consult."

jueves, 25 de mayo de 2017

Acute Salicylate Toxicity

R.E.B.E.L.EM - May 25, 2017 - By Patrick C Ng
Background: Salicylates are common substances that can be purchased over the counter. They are readily available, and in the setting of an overdose, can be fatal. Initially, as salicylates are metabolized, they can induce a respiratory alklalosis. This is then followed by an anion gap metabolic acidosis.
Due to the metabolic derangements induced by salicylates as well as salicylate’s direct stimulation on the respiratory centers of the brain, patients can present with profound tachypnea, fever and even altered mental status. As the severity of toxicity increases, the need for airway protection through intubation and mechanical ventilation becomes more profound...
Author Conclusion:
“Survival was decreased in these patients if hemodialysis was not performed. Mortality increases with the measured serum salicylate level. Timely hemodialysis for intubated salicylate overdose patients decreases mortality.”
Clinical Take Home Point: In patients requiring intubation from acute salicylate toxicity, hemodialysis should be considered as part of management, as this is associated with decreased mortality."

martes, 23 de mayo de 2017

Drug-induced anaphylaxis

Acute Medicine & Surgery
Takazawa T., Oshima K., Saito S. Acute Medicine and Surgery. DOI: 10.1002/ams2.282
(First published: 15 May 2017)
"Conclusions
The initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis. Despite the therapeutic benefits of adrenaline and the recommendations for its use, adrenaline injection rates to treat anaphylaxis remain low in many ERs. Emergency room physicians should have proper knowledge regarding the diagnosis and treatment of anaphylaxis."

lunes, 22 de mayo de 2017

Calabadion

AnestesiaR - Por Robert Blasco Mariño - 22 mayo 2017
"Todavía no comercializado, Calabadion; un nuevo reversor de los bloqueantes neuromusculares. Se une al rocuronio con una afinidad 89 veces mayor que el Sugammadex..."
cala1
Fig 1. Fuente: Expert Opin Pharmacother. 2016;17(6):819-33.

domingo, 21 de mayo de 2017

Damage Control Resuscitation Principles

Resultado de imagen de journal of emergency medical services
JEMS - Apr 1, 2017 - By William Selde
file
..."Trauma remains a major cause of death and disability globally. Damage control resuscitation is a strategy that focuses on attempting to maintain or restore homeostasis in 
trauma patients.
The name "damage control" references the naval tactics employed to keep a damaged ship as combat-capable as possible until definite repair can take place. The concept goes hand in hand with damage control surgery. However, for prehospital care, surgery is clearly beyond the scope of practice and won't be discussed here.
First described in the late 1970s and early 1980s, damage control resuscitation has continued to evolve and is primarily focused on mitigating the life threats of trauma.
The main threats concentrated on in damage control resuscitation are acidosis, coagulopathy and hypothermia. Ideally, these pathologies are all addressed in a simultaneous and balanced manner. These three abnormalities form a forward feedback loop that leads to progressive worsening of a patient's hemodynamic status and will eventually lead to death..."

sábado, 20 de mayo de 2017

Reducing brain injury following CP resuscitation

Report of the Guideline Development, Dissemination, and Implementation Subcommittee 
of the American Academy of Neurology
Published Ahead of Print on May 10, 2017. Neurology® 2017; 88:1–9
..."For patients who are comatose in whom the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32–34ºC for 24 hours) is highly likely to be effective in improving functional neurologic outcome and survival compared with non-TH and should be offered (Level A). For patients who are comatose in whom the initial cardiac rhythm is either VT/VF or asystole/pulseless electrical activity (PEA) after OHCA, targeted temperature management (36ºC for 24 hours, followed by 8 hours of rewarming to 37ºC, and temperature maintenance below 37.5ºC until 72 hours) is likely as effective as TH and is an acceptable alternative (Level B). For patients who are comatose with an initial rhythm of PEA/asystole, TH possibly improves survival and functional neurologic outcome at discharge vs standard care and may be offered (Level C). Prehospital cooling as an adjunct to TH is highly likely to be ineffective in further improving neurologic outcome and survival and should not be offered (Level A). Other pharmacologic and nonpharmacologic strategies (applied with or without concomitant TH) are also reviewed..."

Oxygen Guidelines

"Oxygen is probably the drug that we give the most but possibly has the least governance over. More has got to be good except in those at high risk of type II respiratory failure right?? Well as we know the evidence base has swung to challenge that idea in recent years and the new BTS guidelines for Oxygen use in Healthcare and Emergency Settings has just been published with a few things that are worth reviewing since the original publication in 2008. No apologies that this may be predominantly old ground here, this is an area we’re all involved with day in and day out that is simple to correct and affects mortality..."

Medications in Pregnancy

emDocs - May 15, 2017 - Authors: Hahn  and Riddell J -  Edited by: Koyfman a and Long B
"TAKE HOME POINTS: 
  • Treat the emergency: Sick mom = sick baby therefore BENEFIT >> RISK
  • Have your “GO-TO” and “AVOID” meds memorized or easily accessible (Table 2, above)
  • Strongly consider pregnancy testing of reproductive age women before administering meds or writing new prescriptions when possible and practical. 
  • When in doubt, consult a pharmacist or specialist for more complicated medications and imaging decisions."

viernes, 19 de mayo de 2017

Local Anesthetic Systemic Toxicity

R.E.B.E.L.EM - May 18, 2017 - By  Anand Swaminathan
Post Peer Reviewed By: Salim Rezaie
Definition: A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. Local Anesthetic Systemic Toxicity (LAST) is rare and almost always occurs within minutes of injection of the local anesthetic...
Take Home Points
  • The key in managing LAST is prevention. Know your dose, know your maximum dose, always aspirate prior to injection and ask patient about symptoms
  • Lidocaine toxicity CV complications are typically preceded by neurological signs/symptoms. If these develop, stop administration, place patient on monitor and ready your antidote
  • Bupivacaine toxicity can be sudden and catastrophic. If you are using the drug, undershoot your max dose and know where your antidote is
  • Intralipid has been shown to be effective in LAST. Administer the drug anytime there are signs of hemodynamic compromise"

martes, 16 de mayo de 2017

Massive Hemoptysis

EMCrit Podcast 199 - May 14, 2017 by Scott Weingart


lunes, 15 de mayo de 2017

Submasive PE-s

R.E.B.E.L. EM - Emergency Medicine Blog
R.E.B.E.L.EM - Episode 38 - May 15, 2017 - By Salim Rezaie
Post Peer Reviewed By: Anand Swaminathan
Ref.  Konstantinides SV et al. Impact of thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. J Am Coll Cardiol 2017; 69: 1536 – 44. PMID: 28335835
"Clinical Take Home Point: In the current trial, long-term mortality rates and long-term morbidity (residual dyspnea, functional limitations, and persistent RV dysfunction) were not affected by the use of systemic thrombolysis in unstratified patients with submassive PE. Thrombolysis in submassive PE should now only be considered in patients with signs of submassive PE and either at risk of throwing additional emboli to the lungs (proximal DVT or clot in transit on echo) or patients who appear to be at the brink of massive PE (pale, diaphoretic)."

sábado, 13 de mayo de 2017

POCUS for Pneumonia

EDE Blog
The EDE Blog - May 11, 2017 - Presented by TJ
"There is more and more research looking at the utility of POCUS for diagnosing pneumonia, both in adults and pediatrics. At the EDE 3 journal club, Dr Tom Jelic presented a meta-analysis on the topic published by Alzahrani et al in CUJO, Critical Ultrasound Journal. The title is “Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia“."