Journal Club November 2017 - Large Vessel Strokes

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Journal Club November 2017 - Large Vessel Strokes

Ischemic stroke is one of the most frequently encountered neurologic emergencies. It can be a truly debilitating diagnosis, and yet classically, there has only been one treatment available for small and large vessel occlusions alike– tPA. Now, with the widespread availability of CT angiography and the advent and maturation of interventional techniques such as mechanical thrombectomy, the management of large vessel occlusion (LVO) strokes is rapidly evolving and is increasingly distinct from the management of other strokes. This is truly an exciting time in stroke care, so for this month’s journal club we focused on three questions relevant to the emergency provider:  1) What is the utility of prehospital clinical scales for rapidly identifying LVO strokes? 2) Should patients with suspected LVO be taken to the nearest stroke center or bypass smaller hospitals to reach a comprehensive stroke center?  3)  How effective is mechanical thrombectomy vs. tPA alone?

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Enhancing Human Performance and Flow in Resuscitation

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Enhancing Human Performance and Flow in Resuscitation

Mike Lauria was a pararescueman, providing medical/rescue support for special operations throughout the world.  Through this experience, he learned how to use psychological skills to perform under acute stress.  We were fortunate to have him join our winter symposium this year, discussing the cognitive science behind stress and performance, as well as how to use performance enhancing psychological skills for acutely stressful conditions. 

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To the Cath Lab or Not? You Make the Call! - Part 2

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To the Cath Lab or Not? You Make the Call! - Part 2

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Here is part two of our two part series (click here for part one).  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

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To the Cath Lab or Not? You Make the Call! - Part 1

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To the Cath Lab or Not? You Make the Call! - Part 1

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

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Resus of the Hypotensive Patient Part 2 - Why You Should be Using Peripheral Pressors (and not feeling guilty about it)

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Resus of the Hypotensive Patient Part 2 - Why You Should be Using Peripheral Pressors (and not feeling guilty about it)

For the patients we see that are potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discussed how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.  So how do we avoid the harms of excessive IV fluids?  Plan to start peripheral pressors.  

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Resus of the hypotensive patient Part 1 - When IV Fluids Kill

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Resus of the hypotensive patient Part 1 - When IV Fluids Kill

There is probably no other drug emergency providers administer more often than IV fluids.  We give them to patients with mild heat exhaustion, gastroenteritis and orthostatic dizziness to name a few.  These patients tend to feel better, go home and no harm comes to them.  However, for the subset of patients with shock and potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discussed how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.    

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What the Heck is Going on with this Pacemaker?!

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What the Heck is Going on with this Pacemaker?!

Pacemakers and implantable cardioverter/defibrillators (ICDs) are fascinating little machines.  They were first placed in survivors of sudden cardiac death in 1980, and over the past several decades have become more complex with increasing abilities to sense, pace and defibrillate.  As the population ages and the prevalence of cardiovascular disease increases, patients with pacemakers and ICDs will present more commonly to the emergency department.  It is imperative that the emergency provider have a framework for troubleshooting these devices.  This post will briefly review the use of the "donut" with an implantable pacemaker, as well as three pacemaker malfunctions the emergency provider may encounter.

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