recent articles

intern report

tPA

While working on the Neurocritical care service, I have enjoyed seeing the teamwork between neurologists and emergency medicine physicians. Neurologists rely on the EM physician to inform them of potential stroke patients in the ED, while EM physicians use the neurologist as a guide in treatment management; however, in my short time on the service, I have seen a vast array of opinions on the administration of tPA. Tissue plasminogen activator or alteplase is a fantastic drug that saves lives when used in the right patient population. That is where the controversy lies. What is the right patient population and how do we avoid wasting valuable resources on non-stroke patients?

Ask Me Anything

Ask Me Anything – Kevin Klauer, DO, EJD, FACEP

We're excited to announce our next AMA: Kevin Klauer will be with us TODAY: Tuesday, September 2nd, from 2-4pm CST.

Some background on Dr. Klauer from his bio page on emp.com:

  • Chief Medical Officer of Emergency Medicine Physicians, one of the leading providers of emergency medical services in the nation
  • Has received the ACEP National Faculty Teaching Award and the EMRA Robert J. Dougherty Teaching Fellowship Award
  • He is the ACEP Council Vice Speaker and serves as Medical Editor-in-Chief for ACEP Now
  • Co-author of two risk management books: Emergency Medicine Bouncebacks: Medical and Legal and Risk Management and the Emergency Department: Executive Leadership for Protecting Patients and Hospitals
Hope you can join us!  
Live Blog Ask Me Anything with Kevin Klauer
 

practice updates

A #FOAMed Roadmap to Permissive Hypotension

Included below is a summary of numerous blog posts and podcasts that discuss the sometimes controversial issue of permissive hypotension or minimum volume resuscitation in the bleeding trauma patient.

The Basics

  • Idea of keeping BP low in traumatic hemorrhage to avoid “popping the clot”
  • Based mostly on data from animal trials and penetrating trauma in humans
  • Common practice in most major trauma centers in USA
  • The exact approach still remains controversial around the world
Disclaimer: These are highlights as interpreted by the author of this article and should not replace listening to the original podcast or reviewing the background research.  Posts are in chronological order and many of the below podcasts go beyond the scope of permissive hypotension. [...]

intern report

Echocardiograms in Typical vs Incomplete Kawasaki’s

On my first shift in the Children’s ED, I saw a child with what appeared to be Kawasaki’s Disease. She was a referral patient who had been seeing her PCP throughout her current illness. The child’s PCP had done appropriate lab work on her, and the results combined with the child’s clinical picture warranted a referral to our ED for further evaluation and management. When she presented to us, her symptoms seemed to be resolving. She had bilateral conjunctivitis that her mom stated was improving, she had a mild rash and swelling of her tongue and she had a dry and peeling rash in her genital region. Her mother stated that her limbs had been swollen but were now returning to normal size and that her fever had been high and unrelenting for several days, but was normal (36.7 and 37.0) in our ED. To me, this child was healing and did not require treatment at this time. But the question was whether or not an echocardiogram was indicated for this patient. [...]

practice updates

End Tidal CO2 in TBI

Does End Tidal CO2 correlate with PaCO2 in Traumatic Brain Injury? Your neurosurgeons and trauma team have accepted a transfer to your hospital for intensive management of a trauma patient who presented to a small community hospital with a traumatic subarachnoid hemorrhage and epidural hematoma after being involved in a motorcycle accident. Upon arrival with the critical care transport team, the patient is already intubated and stable on a a ventilator with appropriate sedation and stable hemodynamics. However, the neurosurgeons are in the operating room managing a spontaneous intraparenchymal hemorrhage and there are no available ICU beds due to multiple gun shot victims from a gang fight that you finished admitting. While the patient is in the ED, the neurosurgeons recommend maintaining eucapnea for the patient since while there are no acute signs of herniation.(1) Can you use the end tidal CO2(etCO2) or do you need to rely on arterial blood gas (ABG) measurements to maintain PaCO2 between 35-40 mm Hg? [...]