armyemdoc

Read the story 👇 It's so often that those of us who work in EM and critical care see devastating injuries and wonder whether we're really making a difference... SPC Jordan Kirkpatrick is a @usarmy Soldier who was riding his motorcycle on his day off when he had a high-speed…

Can personalizing septic shock care with a capillary refill time improve outcomes? In this well-designed RCT, the short answer was yes -- it did improve outcomes. This great because the monitoring method can be done anywhere and is virtually free (other than a few minutes of…

The BICARICU-2 study came out today. In this study, they found no difference in 90 day mortality between those that received a bicarb infusion (n=314) and those that did not (n=313). The intervention was 4.2% bicarb targeting a pH >7.30 with a max of 1000mL in the first 24h…

A recent systematic review with meta-analysis looked at steroids for vasopressor refractory shock in sepsis. Of the 18 RCTs with almost 8000 patients, they found a 4% absolute reduction in mortality with moderate dose steroids (200-300 mg/day hydrocort equivalence) with a risk…

Coworker: "What's that smell?" Me: "Sorry, I was doing some enteral exhalation."

A recent systematic review with meta-analysis of 6 RCTs found that in neonates undergoing emergency intubation, VL was superior to DL for first-pass success with a NNT of 6. This is particularly helpful for those of us that do not routinely intubate neonates but may, on rare…

Despite decades of blanket use of epinephrine in cardiac arrest with only marginal benefit, at best, in select populations, ILCOR continues to protect this sacred cow. One thing is clear, epinephrine increases ROSC and hospital admission rates... What is not clear is if it…

Ever wondered where the critical threshold is for HBG where the lack of oxygen delivery secondary to anemia will cause a lactate elevation? It is around 5g/dL. The best available is from a study in 1998. In this study, they performed isovolemic reductions in HGB in healthy…

A recent systematic review with meta-analysis comparing CPAP versus HFNC found... -CPAP is better than HFNC -No mortality difference (7494 patients, 18 RCTs) -Reduced need for invasive mechanical ventilation (5900 patients, 22 studies, mix of interventional versus observational…

Happy ER nurses week... ...to all the nurses that can accurately dose pediatric meds in one room, get into a fight with a dude high on meth in the next room, and still have the patience to not go off on me when I order blood cultures 10 minutes after you put an IV in.…

The military is when people you haven’t seen in years message you saying they are in town for one day only, and you drop everything to go and see them. You can’t buy that type of friendship.

Should we routinely anticoagulate subsegmental PE's? We say no, this should be done on a case-by-case basis. Check out our new clinical controversies editorial in @AnnalsofEM: doi.org/10.1016/j.anne… #emergency #emergencymedicine #criticalcare #icu #science #data #research…

“We mourn the loss of CW3 Culley, CW2 Kraus, SGT Scott and SGT Good. We join the entire Army Special Operations Community in providing full support to the Culley, Kraus, Scott and Good families – taking care of them is our sacred obligation.” - GEN Bryan Fenton and CSM AJ Krogman…

My heart is heavy following the news of the September 17 aircraft mishap involving four Soldiers from the 160th Special Operations Aviation Regiment (Airborne) near Joint Base Lewis-McChord. While we await further updates, my prayers are with those involved, their families, and…

Should we be reaching for hyperangulated or standard geometry VL blades? Much to my dismay, a systematic review with meta-analysis of 25 studies and 39k patients published this month found that hyperangulated blades had 4% lower first-pass success with higher risk of airway…

To my knowledge, there is no data that inotropes improve mortality in advanced heart failure. Despite the lack of that endpoint, we still regularly use them to improve patients' symptoms. This algorithm can help achieve that. 🎩 tip to the authors. eddyjoemd.com/foamed

Don't burn patients need to "Swell to get Well"? Posting tomorrow... PFC Podcast 247: Plasma for Burns Link tree linktr.ee/Prolongedfield… @SpecOpsMedics @NextGenComMed @NARescue @DeltaDev_Team @GreenBeretMD @armyemdoc @ATMA_Tactical @emcrit @FlightBridgeED

What is the optimal dose of IN midaz for laceration repair in kids? There are few things more difficult than suturing moving target. In this study published this month, these authors used an adaptive design trial to determine the optimal dose that provided sedation for most of…

We are pleased to present our latest SRMA: Effect of hyperangulated videolaryngoscopy on first-attempt success in tracheal intubations: A systematic review and meta-analysis. sciencedirect.com/science/articl…

Overall, HAVL had lower FAS than SGVL: 87.2% vs 91.0% (pooled RR 0.96, 95% CI 0.94–0.99). That’s ≈4 fewer first-pass successes per 100 intubations.

For those of us the have been out of training for >5 years, what practices that were once dogma have changed? Keeping up with charges in clinical practices is hard, especially when you are not at an academic center. How do our community colleagues stay fresh? #emergency…