Nasal Cannula and Pre-oxygenation

If we add nasal cannula to nonrebreather face mask or BVM with air leak, we will improve pre-oxygenation phase. This study that just published in Annals of EM enrolled 6o Healthy volunteers ,30 nonrebreather face mask and 30 bag-valve-mask. There will be an argument that Healthy lungs will be different from patients with restrictive or or obstructive lung diseases! But this support our routine practice using Nasal cannual with NRB or BVM.

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Migraine and Diphenhydramine!

I am fan of Metoclopramide + Diphenhydramine  or Prochlorperazine + Diphenhydramine for Migraine Headache, and I see a lot of good outcome among patients with headache. Annals of EM published “Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department–Based Randomized Clinical Trial”. I am not sure that I am ready to start practicing this way but will take into consideration.

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Stroke risk stratification in acute dizziness presentations!

Dizziness! one of the most complex and ambiguous term in ED. The first response: what do you mean? But sounds like we need to have more critical thinking than just a vertigo, or lightheartedness. Neurology in Nov.2015 Publishes an article regarding: Stroke risk stratification in acute dizziness presentations! There were 272 patients, 10.7% acute stroke recognized.The combination of ABCD2 score(age, blood pressure, clinical features, duration, and diabetes), , general neurological examination, and a specialized Oculo-motor examination has the capacity to risk-stratify acute stroke on MRI.

For HINTS

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Venous Blood Gas, You Rock!

We had a long journey to get here! I can’t tell how many times that I had argument with consultants regarding COPD or DKA patient that they ask for ABG and we had VBG! My old Post was focused mostly on DKA patient but Thanks to Throax that published a study among COPD patients.

Using venous blood gas analysis in the assessment of COPD exacerbation: a prospective cohort study: UK based study, 234 patients with COPD exacerbation. There is a great agreement between arterial and venous measures of pH and HCO3. The mean difference amazingly looks good in their analysis.

 

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