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practice updates

Amiodarone vs Procainamide for Stable VT

Case Scenario: A 38-year-old male with a history of hypertension and an unknown heart defect status post repair in infancy presents to the Emergency Department with acute onset chest pain, dyspnea, and diaphoresis.  He had a similar episode at another hospital 1 month prior that resolved after "some medication."  He denies drug use. An EKG is obtained in triage, and is shown below. The patient’s blood pressure is 120/70.  He is alert and oriented, and speaking in full sentences although dyspneic with respiratory rate in lower 20s and O2 saturation 98% on RA. Clinical Question: Which pharmacologic agent is most effective for termination of monomorphic ventricular tachycardia?

From @EMSwami

Cardiogenic Shock

Click here to view Tintinalli's chapter on Cardiogenic Shock via Access Emergency Medicine!A 55-year-old man arrives via ambulance in respiratory distress. Paramedics attempted to start an intravenous line but the patient is altered and pulled it out. They were also unable to keep an NRB mask on him. His vital signs are: HR: 132, BP: 71/38, RR: 35, O2Sat: 83% A quick bedside ultrasound reveals numerous B lines in both lung fields and markedly depressed left ventricular function. Based on your quick evaluation, you determine that the patient is suffering from cardiogenic shock. You are familiar with treatment of acute decompensated heart failure (ADHF) but are unclear on the management priorities and appropriate treatments in cardiogenic shock. [...]

practice updates

Spinal Epidural Abscess

"Once the classic symptoms appear and a definitive diagnosis is made, the very symptoms we look for have often become irreversible"
  • Spinal epidural abscess is an extremely rare diagnosis but a potentially devastating one.
  • It has proven to be a difficult ER diagnosis.
  • Unfortunately, once the classic symptoms appear and a definitive diagnosis is made, the very symptoms we look for have often become irreversible.
  • How can we change the way we evaluate for SEA in order to minimize diagnostic delay and thereby decrease morbidity/mortality?

Ask Me Anything

Ask Me Anything with Steve Carroll, DO (@embasic)

Live Blog Ask Me Anything - Steve Carroll, DO
 

practice updates

Beta Blockers in Sepsis

"Beta blockers may improve hemodynamics, organ preservation, pressor requirements, and mortality"
Is there a role for beta blockade in septic patients? It seems counterintuitive, but Cynthia Santos, MD presents some recent literature suggesting a benefit in an ICU setting.

Ask Me Anything

AMA with Anand Swaminathan, MD (@EMSwami)

Live Blog Ask Me Anything with Anand Swaminathan, MD, MPH