End-Tidal CO2 monitoring has a variety of uses in the Emergency Department. Whether used diagnostically or for monitoring of a patient’s physiology, clinicians must possess an understanding of the information that you can gather from EtCO2 waveform tracings. Knowing how to interpret the waveforms makes EtCO2 much more than a number, allowing the clinician to gain insight into minute to minute changes in a patients physiological state.
Read MoreThis week Dr. Diaz starts off with a challenging case of massive upper GI bleed managed with balloon tamponade. We then moved into a case follow-up with profound electrical storm and recurrent ventricular arrhythmias secondary to a STEMI. Following this, we took a deep dive into waveform capnography regarding normal physiology and alterations with lung pathology with Dr. Wilson. Next, we had an exciting CPC showdown where Dr. Bryant successfully diagnosed Dr. Haffner’s case of valproic acid toxicity presenting with hyperammonemic encephalopathy. We closed with Dr. Wosiski-Kuhn outlining the difficulty of intubation in a patient with DKA and severe metabolic acidosis.
Read MoreBoarding of admitted patients in the ED and subsequent overcrowding of ED’s continues to plague hospitals in the United States and Internationally. The Covid-19 pandemic exacerbated an already growing problem regarding capacity management and patient flow. In this current climate, the Emergency Physician’s responsibilities continue to shift toward the front-end of the process, mainly patients waiting to be seen in the lobby. As such, identifying sick patients in a timely manner and utilizing additional resources to predict patients at risk of clinical deterioration will be paramount moving forward.
Read MoreDrs. Winslow and Habib started the Grand Rounds off with a case-based discussion on the Centor Criteria and testing for strep pharyngitis. Drs. Walsh and Sabedra led an interesting discussion about a case of TTP. In his R4 Case Follow Up lecture, Dr. Nagle presented about DKA and family presence during resuscitation. Dr. Hogan, one of the EMS Fellows, gave a great presentation about the current controversies in cardiac arrest management. Finally, the week wrapped up with some great simulation and cases from our PEM fellows about post T&A bleeds, PTA, and acute chest syndrome.
Read MoreBoth pulse oximetry and capnometry rely on the Beer-Lambert Law.
If you were to choose one vital sign for your critically ill patient, what would you choose? Blood pressure? Pulse? Respiratory rate? O2 sat? Temperature? Certainly it’s nice to know if a patient’s BP is super low or sky high, but if you are evaluating someone for the presence of shock, and you are waiting on the BP cuff to cycle one more time, you are already behind in recognizing and correcting the patient’s physiologic derangements.
Read MoreMaking a checklist can help cognitively unload you in high stakes and high pressure situations. Post-intubation consider the following important points:
Protecting the Tube
Continuous wave form ETCO2... each and every time
Secure Endotracheal Tube at the appropriate depth (See LIT week 6)
Analgesia and Sedation
Restraints... Do you know where the soft restraints are stored?
SRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
