TamingtheSRU

In this podcast, Dr. Justin Milligan covers a recently published retrospective review that could inform our future practice. We all rely on a negative CT within 6 hours for diagnosing SAH, but what if we could through the time limits out the window?

During a cardiac arrest resuscitation, finally palpating a pulsatile flow beneath your gloved fingertips brings a sense of satisfaction like no other. But just as you go to finally breathe a sigh of relief and wipe the beading sweat off your brow, your now widening pupils focus on the patient’s steadily plummeting blood pressure. As you begin to sense your own heart palpitating, you think about medications to utilize in hopes of staving off another round of chest compressions. Since you’ve already given four doses of code-dose epinephrine, maybe an epinephrine infusion is best? You also recall that norepinephrine seems to be a popular choice in patients with shock, so maybe you should start that instead?

Cardiac arrests are an inevitable reality for emergency medicine providers. There is often a debate on whether family members presence during CPR will lead to more emotional burdens on the family members who witnessed these resuscitations. Dr Melanie Yates summarizes this recent study that aimed to determine if there are increased rates of PTSD-related symptoms of close relatives who witnessed CPR of a family member.

Palpating a pulse during a resuscitation can be more challenging than it seems. Digital palpation of femoral pulses may lack sensitivity and specificity needed to accurately detect the presence of a pulse. In this Journal Club recap, Dr Martina Diaz summarizes a recently published paper looking at the use of Doppler ultrasound for pulse checks.

In this podcast, Dr. Courtney Kein breaks down a recently published article examining the effects of a bolus of IVF at the time of intubation. Does a push of fluid prevent peri-intubation hemodynamic collapse?

In this Journal Club paper breakdown, Dr Bailee Stark recaps the findings of a recently published study by Driver et al looking at the effect of bougie aided intubation vs standard stylet intubation.

In this Journal Club podcast, PGY-3 Tony Fabiano breaks down a paper from the Journal of Trauma comparing the effectiveness and patient perception of pigtail catheters versus standard chest tubes for hemothorax in the setting of trauma. Is a tiny tube effective at all in draining blood from the chest?

Time is myocardium, and minimizing door-to-activation time improves outcomes in patients with acute coronary occlusion. There are a number of existing quality metrics used to help drive improvements in the time-based care of STEMI patients. Could a new quality metric help the decision making time of Emergency Physicians?

The paradigm of STEMI vs NSTEMI is one of the most well known in Emergency Medicine. Could a change in thinking shift this paradigm to OMI vs NOMI and result in a more complete identification of patients with significant morbidity and mortality?

One of the first tests ordered for a patient with ROSC following cardiac arrest is an EKG. Many of these EKGs are profoundly abnormal. Current practice is to evaluate for STEMI and to activate the cardiac cath lab if one is found. But, the test characteristics (sensitivity and specificity) of post-ROSC EKGs are likely different than the test characteristics for patients presenting to the ED with complaints of chest pain/symptoms concerning for ACS. This meta-analysis looked to pull together the existing literature and determine those test characteristics for this critically ill patient population. Read the summary after the link and listen to the podcast to hear a breakdown of this study.

This is part 3 of 3 recapping our most recent journal club where we looked at the evidence for the safety and efficacy of droperidol for treating acute agitation in the ED. In this final episode, Dr. Christa Pulvino will share her summary of the DORM trial done by Isbister et al which looked at IM droperidol vs midazolam for violence and acute behavioral disturbance in the ED.

This is our second in a 3 part series looking at the evidence for the safety and efficacy of droperidol for acute agitation in the ED. In this episode, Dr. Shawn Hassani leads us in a discussion of an article by Taylor et al which was a randomized trial of droperidol vs droperidol + midazolam vs olanzapine.

This is part 1 of our 3 part series recapping our most recent journal club. In this podcast, Dr Jeff Hill leads a discussion of a paper by Calver et al which was a multicenter prospective trial looking at the safety and efficacy of droperidol for acutely agitated patients in the ED

This is the final of 3 podcasts recapping our most recent journal club. In this podcast Dr. Olivia Urbanowicz walks us through a meta-analysis by Wu et al published in the Journal of Emergency Medicine in 2020. We tackle the question as to whether or not there is evidence that supports the routine use of sodium bicarbonate in patients with cardiac arrest.

In this, our second podcast recapping our most recent journal club, Dr. Colleen Laurence summarizes a recent pilot study by Cheskes et al looking at standard defibrillation vs vector change defibrillation vs dual sequence defibrillation. Could we be on the verge of a significant practice change in how we deliver defibrillation to patients with refractory V Fib/Tac?

This is our first of 3 podcasts recapping our most recent journal club. In this podcast, Dr. Sarah Wolochatiuk summarizes the meta-analysis by Gottlieb et al entitled "Beta-blockade for the treatment of cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia: A systematic review and meta-analysis" published in Resuscitation in 2019.

We cover a trio of papers related to the care of the trauma patient - should we be adding some vasopressin in patients needing >6 units of blood? Is VL really superior to DL in trauma patients? Should we stop wasting time of IVs and just grab the IO drill?

A dive into 3 articles looking at the use of ketamine in the Emergency Department. 01:23 - Slow vs rapid infusion of ketamine for pain control in the ED 13:42 - Hemodynamic effects of ketamine vs etomidate for RSI 21:59 - Effect of versed or haldol vs placebo for emergence agitation in ketamine procedural sedation

We recap 3 recently published articles that look at various aspects of caring for pediatric cardiac arrest patients. Is Epi helpful? Therapeutic hypothermia or normothermia - which is better? Is old school lidocaine better than amiodarone?

In this podcast, we recap our most recent journal club which look at 3 papers on the topic on influenza. One recently published in the BMJ looking at usual care vs oseltamivir for community treatment of influenza-like illness, one looking at baloxavir for treatment of influenza, and a 3rd paper looking at the association of cardiovascular events and influenza infections.