recent articles

intern report

Post LP Headache

On my first month in the Parkland ED, I saw multiple patients with post-lumbar puncture headaches and even iatrogenically caused one myself.  Often I found myself wondering what proven preventative measures during an LP decrease the incidence of such headaches, what could I have done better, and what literature supports treatment of post-lumbar puncture headaches in the emergency department. [...]

clinical cases

Chief Complaint: "Seizures"

Chief Complaint: “Seizures” History of Present Illness: 25-year-old male with no PMHx, BIBEMS after he had episode of tonic-clonic seizure. As per wife, who gave medical history, the patient was found down in a hotel with "his whole body shaking."  Upon EMS arrival, he was given 5mg of Valium. On arrival to the ED, patient combative, not following commands with frothy oral secretions.  Wife endorses that patient has had weakness, dizziness, and malaise x 3 days, but no other complaints. Patient had another seizure while in the ER without regaining full consciousness. [...]

practice updates

ICP Management Update

Author: Albert Arslan, MD and Anthony Scoccimarro, MD (Resident Physicians, Lincoln Emergency Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital)   Prevent and Identify – the ED’s equivalent of Search & Rescue when managing elevated Intracranial Pressures (ICP). The causes of elevated ICP are typically described in the context […]

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. [...]

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. [...]

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? [...]