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.
Tag Archives: FOAMed
FOAM Eye-Catchers 10: Apnoeic Oxygenation – new trial questions value of NODESAT
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
FOAM Eye-Catchers 9: Early Goal Directed Therapy is Dead
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.
First we had PROCESS from the US, then came ARISE from Australia/NZ and now we have PROMISE from the UK.
FOAM Eye-Catchers 7: SMACC GOLD Highlights
Having recently returned from the FOAM-ite mecca, SMACC GOLD, in this edition I take a look at just a few of the many highlights. Given there were frequently 3 speakers on at the same time, there were many talks that I missed so this is not an all inclusive list by any means. Continue reading
FOAM Eye-Catchers 5: ACEP says fasting is not required for procedural sedation in ED
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]
Bite-Sized Basics: Anaphylaxis Management
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.
Lab Case 1 – Interpretation
Below is the interpretation for Lab Case 1
Causes of Acid-Base Disorders
Here are a list of causes of acid-base disorders with some handy mnemonics to help remember them:
Lab Cases: General Approach to Interpretation of Blood Gases
Here we provide a general systematic approach to interpretation of blood gases:
Lab Case 1
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