This is 'A Nuanced Approach to Emergency Management of Hyperkalemia' on EM Cases.
Of all the electrolyte emergencies, hyperkalemia is the one that has the greatest potential to lead to cardiac arrest. And so, early in my EM training I learned to get the patient on a monitor, ensure IV access, order up an ECG, bombard the patient with a cocktail of kayexalate, calcium, insulin, B-agonists, bicarb, fluids and furosemide, and get the patient admitted, maybe with some dialysis to boot. Little did I know that some of these therapies were based on theory alone while others were based on a few small poorly done studies. It turns out that some of these therapies may cause more harm than good, and that precisely when and how to give these therapies to optimize patient outcomes is still not really known...
What? A 3-year-old male presented to the emergency department (ED) with a 12 hour history of a barking cough.He had been running a low-grade temperature (37.5C) but had otherwise been his normal self. His parents had contacted their GP who had diagnosed ?croup and arranged ambulance transfer to the ED for further assessment. A full →
This is Waiting to Be Seen 9 on EM Cases - Improving Follow up From the ED, Quality Assurance Part 1.
We all face the challenge of how to manage final reports that arrive after the patient has been admitted or discharged, but some EDs are more organized and diligent than others in systematically addressing their obligations in this area. In this two-part guest blog, Dr. Lucas Chartier, an emergency physician in Toronto, will discuss best practices in departmental organization in part one and the obligations of the individual physician in part two. No ED will ever be perfect, but there are some positive lessons to share and we likely all can do better in reducing risks related to test result follow-up.
BrainScope, a Bethesda, Maryland firm that’s been working with the U.S. Department of Defense to develop technology for assessing traumatic brain injuries (TBI), just won FDA clearance for its latest device, the Ahead 300. This the first of the company’s products that will actually be distributed commercially and it’s touted as their most advanced version.
It can provide a rapid electroencephalographic (EEG) assessment of a person who suffered a head injury, utilizing disposable electrodes and a connected smartphone to process the information. It relies on the firm’s proprietary algorithms and machine learning to spot certain patterns and correlations within the recorded brainwaves.
Following the test it produces a report that highlights important aspects that are of note. These can then be used to help pin down a diagnosis.
Herewith a quick tutorial on the use and placement of the bifurcated, dual-balloon ‘EZ-Blocker’ bronchial blocker. More videos on the DLT vs BB debate, the other blockers, and troubleshooting advice to follow. Comments welcomed as always!