Critical Care Archives - Page 3 of 9 - The Emergency Medical Minute

Critical Care

Podcast #332: Door To Furosemide Time

Author: Nick Hatch, MD Educational Pearls: Recent study argues that CHF patients receiving furosemide within 60 minutes of arrival had a lower in-hospital mortality than those receiving it after (2.3% vs. 6.0%, p=0.002). A flaw in the study is that there were significant baseline differences between groups. References: Matsue Y et al. Time-to-Furosemide Treatment and…

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Podcast #320: PE in Pregnancy

Author: Don Stader, M.D. Educational Pearls: Pulmonary embolism is one of the leading causes of maternal mortality. There is disagreement among different medical societies about the value of D-dimer as a screening modality. If you use it, consider the rational D-dimer approach whereby you add 250 to your cut-off for every trimester. A useful screening…

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Podcast #319: Cardiac Arrest Survival Factors

Author: Aaron Lessen, MD Educational Pearls: Shockable rhythms like V-fib or V-tach have a better prognosis than patients with PEA or asystole. Recent study has shown an initial electrical frequency in PEA between 10-24/min had worse outcomes than PEA with initial rhythm over 60/min. Patients with an initial electrical frequency in PEA over 60/min did…

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Podcast #316: Abnormalities in Alcohol Intoxication

Author: Michael Hunt, M.D. Educational Pearls: 1% of patients presenting to ED with alcohol intoxication end up going to the ICU. Most common critical illnesses were acute hypoxic respiratory failure, sepsis, and intracranial hemorrhage. Predictive markers: Vital abnormalities (hypoxia, tachycardic, tachypneic, hypothermic, hyperthermia, hypoglycemia) and patients receiving parenteral sedatives had higher incidence of ICU admission….

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Podcast #310: Bicarb in DKA

Author: Gretchen Hinson, M.D. Educational Pearls: Controversial topic. Pathophysiology – acidosis leads to an extracellular potassium shift. Patients in DKA will be intracellularly potassium deplete, but will have a falsely normal/elevated serum potassium. 3 risk of giving bicarb in DKA – alkalosis will drive potassium intracellularly but can overshoot (hypokalemia) and  increase risk of arrhythmias;…

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Podcast #308: Ultrasound in Cardiac Arrest

Author: Aaron Lessen, M.D. Educational Pearls: There is currently debate within the medical community about what constitutes cardiac activity on ultrasound in the setting of cardiac arrest. A recent study has shown there providers looking at the same clips from an echo will disagree about what constitutes cardiac activity. Some of the confusion stems from…

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Podcast #290: The Biochemistry of DKA

Author: Dave Rosenberg, M.D. Educational Pearls DKA commonly causes hyperkalemia, leading to peaked T-waves on ECG. However, DKA causes hypokalemia at the same time. In DKA, glucose cannot be taken into the cells. This signals the body to create and use acidic ketones for energy. This leads to acidosis. To compensate for increased acid, H…

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Podcast #287: Sepsis Bundles

Author: Aaron Lessen, M.D. Educational Pearls Treatment “bundles” are a popular approach to the rapid resuscitation of septic patients. A recent study in New York, where sepsis bundles are mandatory, sought to figure out which aspects of the bundle had impacts on mortality. In a study of 40,000 septic patients, the study found that early…

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Podcast #282: EKG Changes in DKA

Author: Dave Rosenberg, M.D. Educational Pearls EKG changes that can be seen in DKA include ST elevation and peaked T-waves secondary to derangements in K levels. In DKA,  serum K is high, but total body K is low, which can cause said EKG abnormalities. Many things cause ST elevation besides MI, so think beyond STEMI….

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Deep Dive #8: Wintertime Wilderness Medicine

Author: John Winkler, M.D. Dr. Winkler shares his knowledge of wilderness medicine and provides insight on how to prevent and treat conditions such as hypothermia, frostbite and sun blindness. More importantly, he gives us tips on how to stay safe while doing our favorite wintertime activities!

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