Moving forward the frontiers in emergency medicine...

Aviation Medicine

Submitted by christo.philip on August 19, 2010 - 12:30
Presentation Summary: 
Goes over the unique conditions related to aviation along with medications and supplies available to you in an airline in case there is an emergency.

Rhythm Control With Electrical Cardioversion for Atrial Fibrillation and Flutter

Submitted by christo.philip on August 11, 2010 - 21:48
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Journal Name: 
Annals of Emergency Medicine
Article Brief Summary: 

A good article that reviews the use of electrical cardioversion in converting patients that present in 48 hours with new onset atrial fibrillation.  They found no statistical difference in mortality with rhythm control vs rate control although there was a trend towards increased stroke rates in rhythm control which was countered by better quality of life in the same group.

Perhaps it would be worthwhile to have this conversation with the patient and if they want to proceed then shock them to get them back to NSR.

August EMRA blog

Submitted by trent.stephenson on August 11, 2010 - 11:08
Organization / Committee Name: 
EMRA

Welcome to the August edition of EMRA rep update.  John Adams, Thomas Jefferson and John Hancock put American policy on paper over 200 years ago and as times change so do parts of the policy.  EMRA also has written policy which outlines the meaning for its existence as well as provide structure for its evolution.  EMRA allows its members to analyze its current policies and to make changes if desired.   The mechanism for change is with a resolution.  Kaedra Jackson, the current speaker of the council, gives a great description of this process in the new “EM R

Read more...

Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest

Submitted by larissa.velez on August 10, 2010 - 21:12
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Journal Name: 
NEJM
Article Brief Summary: 

So, hypothermia has been around for a while...
Note: the study was in adults with VF/pulseless VT arrest only!!!
75/136 (55%) had a favorable neurologic outcome in the hypothermia (cooling to 32-34 degrees with extrenal cooling) group vs 54/137 (39%) in the control (RR 1.4). Mortality was also lower at 6 months in the hypothermia group. Complication rates were similar.

Computed tomography of the head before lumbar puncture in adults with suspected meningitis

Submitted by larissa.velez on August 10, 2010 - 21:03
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Journal Name: 
EJM
Article Brief Summary: 

The article on who to CT before an LP for meningitis, adults only.
Bottom line: Can do LP without Ct scans in those age <60, no seizures in the previous week, not immunocompromised, no prior hx of CNS disease AND normal neuro exam, which they defined as normal level of consciousness; able to answer two consecutive questions or follow two consecutive commands; no gaze palsies; no visual field deficit; no focal weakness (CN or extremities); normal language. I thought o papilledema was here as well, but glancing at it now cannot find it.

Multidetector computed tomography for acute pulmonary embolism

Submitted by larissa.velez on August 10, 2010 - 15:10
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Journal Name: 
NEJM
Article Brief Summary: 

The rseults of the PIOPED II study. PPV's of CT-A were between 92-96%, but about 10% on studies were undetermined due to poor image quality. CTA-A with CT-V (venous phase added) was better than just CT-A only, but only slightly.

Management of cocaine-associated chest pain and myocardial infarction: A scientific statement from the AHA ACC Committee

Submitted by larissa.velez on August 10, 2010 - 14:59
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Journal Name: 
Circulation
Article Brief Summary: 

A scientific statement you should know. One of the authors is Dr. DeLemos, who works here. 

A practical approach to acid base disorders

Submitted by larissa.velez on August 10, 2010 - 14:54
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Journal Name: 
West J Med
Article Brief Summary: 

A simple discussion on how to interpret ABG's

Management of alcohol withdrawal delirium

Submitted by larissa.velez on August 10, 2010 - 14:50
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Journal Name: 
Archives of Internal medicine
Article Brief Summary: 

An evidence based guideline on the management of ethanol withdrawal. Good read.

Influence of Inspired Oxygen Concentration on Deadspace, Respiratory Drive, and PaCO2 in Intubated Patients with Chronic Obstructive Pulmonary Disease

Submitted by drew.shedd on August 7, 2010 - 12:44
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Journal Name: 
Critical Care Medicine
Article Brief Summary: 

A single-blinded prospectice study on the effect of PaO2 in respiratory drive on COPD patients in respiratory failure.  Debunking hypoxic drive?  You be the judge, and let us know what you think.  There are plenty of references at the end of this article on the same topic that can be read as well.  Something to think about...