#FOAM

The sepsis patient not improving after IV fluids and resuscitation: What should be considered? How can we improve?

You are in the midst of caring for a 62 year-old male who is tachycardic with HR 120, BP 88/42, T 101.2 oF, RR 26, and SpO2 98%. He was brought in by EMS for fever and myalgias, and with one look at his vital signs, he triggered the protocol for SIRS.

Your initial exam showed similar vital signs, with dry mucous membranes but otherwise normal HEENT exam, clear lungs, normal mental status, nontender abdomen, normal skin and genitourinary exams, and normal extremities/back. Due to his vital signs and SIRS criteria, you were concerned and ordered CBC, RFP, LFT, lactate, blood cultures, urinalysis/culture, and chest xray. You started 1 L NS, and his VS did not improve.

The sepsis patient not improving after IV fluids and resuscitation: What should be considered? How can we improve? Read More »

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. […]

Capnography in the ED Read More »

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
 

Ask Me Anything – Kevin Klauer, DO, EJD, FACEP Read More »

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. […]

A #FOAMed Roadmap to Permissive Hypotension Read More »

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? […]

End Tidal CO2 in TBI Read More »

emdocs privacy policy. The em educator series : endometritis. The cognitive institute of dallas in partnership with.