Now usually I don’t go and make wild conjectures and hypotheses. But Im going to discuss a pretty interesting (wild conjecture?) one that on paper seems to make sense to me. Let’s look at the COVID-19 risk factors for who gets severe disease and put them in a molecular and biological framework. If you want you …
What No COVID? Then at Least Lets Talk Steroids- in ARDS that is…
Reference: Villar. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 2020; 8: 267–76. I know what you are thinking, “What gives? No COVID!” Well the two of you who read this are probably inundated with COVID info. So to give our brains a change I thought I would …
Permissive Hypotension and Shock
Randomized Trial of 3 AEDs for Status
Kaput, J et al. Randomized Trial of Three Anticonvulsants Medications for Status Epilepticus. NEJM 2019;381;2103-13 This was a randomized, double-blinded, national multicenter pragmatic study to determine comparative effectiveness of traditional anti-epileptic medications in status epilepticus. The purpose of this study is to see if there is a difference between levetiracetem (Keppra), fosphenytoin (Cerebyx), and valproate (Depakote) in treatment of …
We’re Back Baby!! The Quick hit article: For ESBL, Just Say NO to PIP/TAZO
Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance A Randomized Clinical Trial This was a randomized, double-blinded, international multicenter pragmatic (phew! That’s a mouthful!) study to determine if piperacillin/tazobactam (pip-taz) is non-inferior to meropenem. The reason for this study is to see if …
Quick Hit Article: Difficult vascular access: You know the drill… but do you really know the drill?
Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Ann Emerg Med. 2018;71:588-596. THE BOTTOM LINE This study was a secondary analysis of a large EMS trial conducted in 7 sites in the US and Canada. This is a really interesting study that looks …
QUICK HIT ARTICLE: News Flash Breathing is good for you…next up Water, Wet! “How breathing can help you make better decisions…”
De Couck et al. International Journal of Psychophysiology 139 (2019) 1–9. doi: 10.1016/j.ijpsycho.2019.02.011 THE BOTTOM LINEIn this experimental study of 56 undergrad and grad students in France, utilizing specialized breathing patterns (see image below), the researchers sought to determine the effect of breathing on stressful decision making. They found that using breath patterns for 5 …
Case Report: IV access in a dialysis patient: An Evidence free zone!
So the below is only my opinion! We are definitely in an evidence free zone and this is not meant to guide management! However this is my nightmare. A 53 yo ESRD is BIB EMS to a small community hospital. Her chief complaint: missed dialysis. She reports staying at her NH and not having been …
LVAD Complications: A review
This is a nice little review by Dr. Long in Dallas entitled: B. Long, J. Robertson, A. Koyfman, et al., Left ventricular assist devices and their complications: A review for emergency clinicians, American Journal of Emergency Medicine, https://doi.org/10.1016/j.ajem.2019.04.050 INTRODUCTION: A ventricular assist device (VAD) can be placed into the right, left, or both ventricles thus …
ST segment elevation in aVR is probably NOT a STEMI…BUT, damn, are they sick!
There I said it. Well Ok I’ve been saying it for a while. But say this to a room full of doctors and you might be ostracized! Well there has been mounting evidence that would argue aVR ST elevation is not an acute STEMI/ STEMI equivalent for a while now. I think this article clinches …