EM/IM Sessions

EM/IM Sessions: VANISH Trial

Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Gordon, AC, et al. JAMA 2016 [paper] Why I chose this article The kidney is painfully fragile, often one of the first organs to fail in septic shock. According to the last several iterations of the Surviving Sepsis Campaign Guidelines,

EM/IM Sessions

EM/IM Sessions: High-Sensitivity Troponin T

Mokhtari A, Lindahl B, Smith JG, Holzmann MJ, Khoshnood A, Ekelund U. Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events. Ann Emerg Med. 2016;68(6):649-658.e3.  [paper] Why I chose this article  High-sensitivity cardiac troponin T (hs-cTnT) is a relatively new biomarker assay and

EM/IM Sessions

EM/IM Sessions: Assessing Fluid Responsiveness

Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?. JAMA. 2016;316(12):1298-1309. [paper] Why I chose this article We ask this question for every critically ill patient who remains hypotensive after what we believe is adequate fluid resuscitation. Knowing techniques to reassess these

Critical Care

We Have No Beds: Ventilator Series

We Have No Beds: Ventilator Series Noninvasive Ventilation Part 2 Remember our 60 yo male with COPD who has been on NIV for about an hour, he was looking a little less sick, let’s check back in with him. (If you missed the last post click here) Our initial settings for the BiPAP: rate 8,

EM/IM Sessions

Journal Club: Limited English Proficiency and ED Revisits

The Association between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 Hours. Ngai, Ka Ming et al., Annals of Emergency Medicine. August 2016: 68(3), 213 – 219 [paper] Why I chose this article? I was excited to stumble across it in Annals as I have an interest in evaluating the quality of care we provide

Critical Care

We Have No Beds: Ventilator Series

We Have No Beds: Ventilator Series Noninvasive Ventilation Part 1 It’s a busy night in the ED and in comes… …a 60 y/o male with OSA and COPD in extremis, sitting up on the gurney gripping the side rails, huffing and puffing, struggling to breathe.  You are informed that he has not used his CPAP in

EM/IM Sessions

Journal Club: Procainamide vs Amiodarone for Stable VT

Randomized comparison of intravenous procainamide vs intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia:  The PROCAMIO study.  Ortiz et al., 2016 European Heart Journal [paper] Why I chose this article? The ACLS guidelines are quite specific on how to approach unstable conditions such as cardiac arrest.  They become much more vague and

EM/IM Sessions

Journal Club: Andexanet Alfa for Reversal of Factor Xa Inhibitor Activity

Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med. 2015 Dec 17; 373 (25): 2413-24. PMID:26559317 Background Direct factor Xa inhibitors (apixiban, rivaroxaban, edoxaban) are the novel agents being used in the prevention of stroke in patients with non-valvular afib, secondary prevention of

EM/IM Sessions

Journal Club: Challenges with HS-Troponin Elevations

Article Everett BM. Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes. New England Journal of Medicine. 2015 Interest Elevated troponin levels in the ED and inpatient medicine create a challenge for the best treatment methods for patients. Do all patients with elevated troponin require inpatient admission? Does surgical intervention help with outcome

EM/IM Sessions

Journal Club: Lactate Clearance Is Flawed?

Article: Lactate clearance as a target of therapy in sepsis: a flawed paradigm. PE Marik. R Bellomo. OA Critical Care 2013 Mar 01;1(1):3 Why This Article? Though not a conventional journal review article the discussion is interesting and by a credible author (PE Marik; Early goal directed therapy). As for lactate, in both the Emergency