Several pieces of gold in the FOAM world from doctors Stephen Smith and Amal Mattu have highlighted the importance of ST changes in ECG lead aVL for diagnosing and excluding inferior and lateral STEMIs.
A new RCT called the FELLOW trial examining the benefits of NODESAT (Nasal Oxygenation During Attempts at Larngoscopy) has been published online and Emcrit has just released a podcast interviewing the leader author. There is also a brief review of this paper at emlitofnote.
This is a RCT in a single medical ICU randomising patients to NODESAT or usual care. Surprisingly it found no benefit in the primary outcome – the lowest measured arterial oxygen saturation.
However there was some key aspects of this trial that seriously affect its generalisability to ED and operating room patients: Continue reading
Apologies for the recent hiatus in FOAM Eye-Catchers – have had my head down in fellowship exam study.
The big news of late is that the 3rd episode in the trilogy of multi-centre trials evaluating Early Goal Directed Therapy (EGDT) for septic shock has been released.
HOT OFF THE PRESS: ACEP has just published a new Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department, in the February edition of Annals of Emergency Medicine. After reviewing the relevant literature they have made several important recommendations including:
1. Do not delay procedural sedation in adults or pediatrics in the ED based on fasting time. Pre procedural fasting for any duration has not demonstrated a reduction in the risk of emesis or aspiration when administering procedural sedation and analgesia [Level B]
In this Bite-Sized Basic we take a look at the ED management of Anaphylaxis.
In Beyond the Basics, we provide some tips for recognition of tricky cases.
Here are a list of causes of acid-base disorders with some handy mnemonics to help remember them:
Here we provide a general systematic approach to interpretation of blood gases:
Describe and interpret this arterial blood gas:
History: 45y male found in his garage. Brought in by ambulance with altered mental state. His arterial blood gas on arrival (FiO2 = 0.21%):
pH 6.90 Na 153
pCO2 20 K 4.1
pO2 115 Cl 109
HCO3 4.0 Glucose 5.2
COHb <1.0% Urea 5.5
Ethanol <0.01% Osmolality 335