Fernando et. al. HELPFUL ONLY WHEN ELEVATED: INITIAL SERUM LACTATE IN STABLE EMERGENCY DEPARTMENT PATIENTS WITH SEPSIS IS SPECIFIC, BUT NOT SENSITIVE FOR FUTURE DETERIORATION Journal of Emergency Medicine, Vol. 54, No. 6, pp. 766–773. https://doi.org/10.1016/j.jemermed.2018.01.040 BOTTOM LINE: A lactate >4 in this prospective observational cohort study of almost 1000 patients with the “CMS” definition …
To B (VM) or Not to B (VM) THAT is the question!
Source: Casey et. al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. NEJM. February 18, 2019DOI: 10.1056/NEJMoa1812405 Whether ‘tis noble in the mind to suffer the slings and arrows of aspiration or by bagging end them? This is a great methodological (and probably landmark) trial by the impressive authors at Vanderbuilt et al. They have been …
Antibiotic StewardSHIP…Moveover Titanic…there’s a new failure in town.
Tamma, et al. Rethinking How Antibiotics Are Prescribed: Incorporating the 4 Moments of Antibiotic Decision Making Into Clinical Practice. JAMA. 2018 Dec 27. doi: 10.1001/jama.2018.19509. [Epub ahead of print] BOTTOM LINE: Providers should be asking themselves: “What is the likelihood my patient has an infection and that it requires antibiotic therapy?” Those who know …
End Tidal CO2 – How to Read Like a Pro: UPDATED!
Click THIS LINK to view my lecture on “How to Read ETCO2 like a Pro!” This is a recording of a lecture I gave at a Pre-Hospital Conference. I learned a lot doing this lecture. I can really appreciate the value of the capnograph now
Macrolide Resistance: Is Resistance Futile?
There hasn’t been an update to the IDSA/ATS guidelines for CAP (community acquired pneumonia) since 2007 (I keep hearing they will be out soon). These guidelines recommend a macrolide antibiotic as first-line therapy for previously healthy patients who have no risk factors for drug-resistant S. pneumonia (SPN) infection (strong recommendation) and a combination of a …
SO YOU THINK YOU KNOW CELLULITIS?
Sometimes things aren’t as they seem. As an attending I often hear from a resident “Hey got an easy one for ya, 50 y/o diabetic with bilateral cellulitis vanc given, I’ll get some admit labs” followed by a precipitous mic drop. I was told once that a good attending “makes a difficult case simple and …
SUP-ICU Trial: Pantoprazole in patients at risk for Gastrointestinal Bleeding
SUP-ICU Trial Kart, M. Pantoprazole in patients at risk for Gastrointestinal Bleeding in the ICU. N Engl J Med 2018;379:2199-208. Trial done in the UK. It was a multicenter, stratified, parallel group, placebo controlled blinded randomized trial. Included pts admitted to the ICU who were 18 yo or older and had at least one risk …
HYPONATREMIA 2.0
HYPONATREMIA PART I – TREATMENT RECOMMENDATIONS IN CASE OF HEMODYNAMIC INSTABILITY, THE NEED FOR RAPID FLUID RESUSCITATION OVERRIDES THE RISK OF AN OVERLY RAPID INCREASE IN SERUM SODIUM CONCENTRATION. TREATMENT GOALS: An increase by 4-6-mmol/L [Na] is sufficient to reverse most serious manifestations of acute hyponatremia. Increase [Na] no more than 10 mEq/L in 24 hour …
Its beginning to look a lot like…Research: Parachutes, Pharma and Golf; Oh My!
Ahhh….December! While some people look forward to christmas music, jingle bells, Jack Frost and New Years, most of us (well maybe just me) see December as one of the most evidenced based times of the year! Yes every December the classic and so-very –British tongue in cheek version of the BMJ comes out to delight our …
Aspirin for All Comer Chest Pain: Is it Naughty or Nice
Like it or not, we do a fair amount of primary care medicine in the emergency department. Therefore, we need to know some of the basics about primary care. One of the most fundamental concepts is the use of aspirin for prevention of MI either before the first one (primary) OR after (secondary) your patient …