TamingtheSRU

In this journal club breakdown, we analyze an article examining the relationship between invasive arterial line blood pressure measurements and non-invasive cuff measurements.

Can the addition of high-dose methylprednisolone to the treatment of out-of-hospital cardiac arrest make a meaningful difference? In this post-hoc analysis of a placebo-controlled randomized control trial comparing high-dose methylprednisolone versus placebo in out-of-hospital cardiac arrest (OHCA), the authors aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients.

In this podcast, Dr Charlie Brower PGY-3 at the University of Cincinnati leads a discussion of a recent journal club article looking at the impact of a subcutaneous insulin treatment pathway for mild and moderate DKA. We explore the financial and operational impacts of this pathway as compared to traditional treatment with IV insulin

Pain from rib fractures can be severely limiting in the acute setting. In this recap from our most recent Journal Club, Dr Olivia Gobble leads us through a paper looking at the effectiveness of Serratus Anterior Plane Blocks for treating pain from rib fractures in the Emergency Department.

Ultrasound is an increasingly ubiquitous tool to augment the physical exam in the Emergency Department. Dr Jazmyn Shaw walks us through a paper that looks at whether or not US is a useful adjunct to physical exam for the diagnosis of shoulder dislocation in the Emergency Department

Dr Casey Glenn walks through a study analyzing the 'lever test' for the diagnosis of ACL tears in the acute setting. Given significant swelling and pain the acute diagnosis of ligamentous injury can be both challenging and painful to patients. The lever test is a promising physical exam maneuver that may be more accurate and better tolerated that traditional exam maneuvers.

In this journal club podcast we break down 2 articles. Do we need to reduce doses of ketamine or etomidate in RSI to avoid post-intubation hypotension? Should video laryngoscopy fully and finally replace direct laryngoscopy in the ED?

Drs. Wilson and Arnold discuss the latest research that went into their development of a protocol for managing Acute Liver Failure

Dr Marlena Wosiski-Kuhn recaps a recent journal club covering the paper by Mahajan and colleagues: Serious Bacterial Infections in Young Febrile Infants with Positive Urinalysis Results.

Boarding of admitted patients in the ED and subsequent overcrowding of ED’s continues to plague hospitals in the United States and Internationally. The Covid-19 pandemic exacerbated an already growing problem regarding capacity management and patient flow. In this current climate, the Emergency Physician’s responsibilities continue to shift toward the front-end of the process, mainly patients waiting to be seen in the lobby. As such, identifying sick patients in a timely manner and utilizing additional resources to predict patients at risk of clinical deterioration will be paramount moving forward. This recap covers a paper that looks to see if EtCO2 can play a bigger and better role in the triage process

Dr Gillespie breaks down the recently published CLOVERS trial that looked into the early administration of vasopressors in sepsis

The management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction. The presence of HFrEF limits pharmacologic options for rate control. This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure

Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.

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?