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practice updates

Can’t Intubate Can’t Ventilate

“Can’t Intubate Can’t Ventilate” is one of the frightening statements that causes massive surges of adrenaline in everyone. Unfortunately, most neural synapses don’t function well with that large surge of adrenaline, and it is, therefore, imperative to contemplate how to manage this scenario before it arises.

practice updates

Pearls for the management of GSW associated traumatic injury

The patient with GSW can present in a variety of states ranging from hemodynamic stability to loss of pulses. Several literature updates have evaluated specific components of the care of these patients including airway, breathing, hemorrhage control, thoracotomy, and REBOA. This post evaluates the updated literature and provides pearls and pitfalls in the care of these potentially sick patients.

practice updates

R.E.B.E.L. EM – Is Apneic Oxygenation Overhyped? with Scott Weingart

ApOx is a concept that has been around for some time in the operating room literature, but only recently been gaining acceptance in the ED, especially after the publication of this concept by Scott and Richard Levitan in the Annals of Emergency Medicine in 2011 [1]. Many nay sayers will argue that the OR studies were in controlled settings with elective surgical patients who were not in critical condition. The believers would argue that ApOx makes sense, its low cost, and low complexity. To date there has been no randomized controlled trials (RCTs) on ApOx in the ED. There has been one ICU Trial (i.e. The FELLOW Trial) [2] and an even more recent observational trial in the ED [3] that have been published on the topic of ApOx. So the question remains: Is Apneic Oxygenation Overhyped?


Unstable Sepsis: Airway First? Not Always

Intubation, especially in the septic and critically ill patient, can, by itself, cause hemodynamic abnormalities and/or hypoxemia and hypercapnea. In some situations, it may be important to make sure that the patient is adequately prepared for intubation, both from hemodynamic and pre-oxygenation standpoints. This is a brief review of some suggestions when intubating the very ill patient in the emergency department.