Introduction: As medicine is ever changing, new diseases and symptomatology are being classified differently according to the etiology, presentation, clinical findings, and treatments of subsets of disease pathology. There have been various names throughout the continued advancement of medicine for acute pulmonary edema, but there have also been various clinical findings and differences in treatments …
Continue reading Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
Title: The Utility of Midline Intravenous Catheters in Critically Ill Emergency Department Patients. Ann Emerg Med. 2019 Dec 24. pii: S0196-0644(19)31236-3. doi: 10.1016/j.annemergmed.2019.09.018. What is already known about this topic?Previous studies have shown midline catheters inserted in upper arm veins have lower complication rates compared to central lines, and high rates of successful placement in …
Continue reading Midlines in the Emergency Department; a literature review
Introduction Throughout the worldwide pandemic of COVID, the general understanding became that pediatric patients were not only less susceptible to the virus but also to the clinical symptoms that accompany it. Albeit rare, Multisystem Inflammatory Syndrome in Children (MIS-C) is a relatively new differential diagnosis that does not necessarily need positive COVID testing and in …
Continue reading Multisystem Inflammatory Syndrome in Children (MIS-C)
Troubleshooting the Ventilator Terms to know: Tidal Volume (TV)= amount of air that moves in or out of the lungs with each respiratory cyclePlateau Pressures (PPlat)= reflect pulmonary compliance as well as the pressure applied to small airways and alveoli. It can be measured by applying a brief inspiratory pause after ventilation. Peak Pressures (PIP)= This …
46 year old male presents to the Emergency Room after eating a peanut, face swollen with inspiratory stridor. EMS reports being unable to intubate with the patient currently having a saturation of 78% on 100% CPAP. You take a look with your laryngoscope and see edema with no sign of vocal cords. The patient becomes …
A 64 y.o patient with a history of ALS presents to the ED with shortness of breath. On exam, he is alert but appears to be taking shallow respirations. He has a history of chronic diaphragmatic weakness secondary to his ALS and is on NIPPV at night. His saturation is 94% on room air. You …
Continue reading Critical Care Corner – Respiratory Parameters
A 69 y/o female presents via EMS with altered mental status. The patient is able to tell you her name, but can’t answer any other questions. Her husband states that she has cirrhosis and recently has been having increasing ascites as well as anorexia. She has not been compliant with her lactulose. On exam she …
In the ED we are often concerned about the pH, CO2 level, and oxygen saturation of patients. How does one determine whether to get a venous blood gas (VBG) or arterial blood gas (ABG)? ABGs are typically seen as the “gold standard” for evaluating pH, PaCO2, and HCO3 but in certain situations VBGs are a …
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