Category Name: practice updates

practice updates

Lyceum Bullets: DKA

Questions Addressed: When you are suspicious for DKA do you obtain a VBG or an ABG? How good is a VBG for determining acid/base status?Do you use serum or urine ketones to guide your diagnosis and treatment of DKA?Do you use IV bicarbonate administration for the treatment of severe acidosis in DKA? ...

practice updates

Nuances in Resuscitation Part III: Diabetic Ketoacidosis

Thus far we have discussed resuscitation in trauma and sepsis.  What distinguishes those two from the resuscitation goals in DKA is timing.  In trauma and sepsis, it’s all about early recognition, aggressive and quick optimization, and understanding all the possible treatment options at your dis...

practice updates

Nuances in Resuscitation Part II: EGDT In Sepsis

In November 2001, Dr. Manny Rivers and his colleagues published an article in the New England Journal of Medicine on Early Goal Directed Therapy in Sepsis.  At the time, sepsis was not a new concept, nor was the treatment of it.  Where I believe the real genius in EGDT lies is in a fanatical focus...

practice updates

Practical Nuances of Resuscitation: Not All Are Created Equal (Part 1)

One of my colleagues likes to tell our residents, “they don’t come to the ED to die, they come here to live.”  It is our skill in identifying critically ill patients and successfully resuscitating them that defines us as emergency medicine physicians.  Resuscitation in its simplest term mean...

practice updates

Peripheral Vascular Injury Management

Introduction Peripheral vascular injury can be life-threatening or limb-threatening.  Proper understanding of pathology and management is important in the ER. Vascular injuries can be internal and may not be obvious on presentation. Patients with blunt or penetrating trauma who remain hypotensi...

practice updates

Capnography in the ED

Continuous quantitative waveform capnography, also known as end-tidal carbon dioxide, PetCO2, or ETCO2, is a measurement of the partial pressure of CO2 in the exhaled breath. This technology has been around since the mid-19th century and only relatively recently has its potential in emergency medicine begun to be explored. [...]

practice updates

Pediatric Sepsis Update

Sepsis is the most common cause of death in children worldwide. What is the optimal evaluation and management of pediatric sepsis?