Pediatric cardiac arrests are, potentially, some of the most challenging patients for an emergency physician to care for. Cognitively, emotionally; these patients push us to our very limits. In this journal club recap, we cover 3 recently published articles looking at the care of these patients. Should survivors be cooled? Is Epi any good? Which is better amiodarone or lidocaine?
Read MoreEnjoy this week’s Grand Rounds Recap! Dr. Jordan Bonomo started us off with a fascinating talk on brain death, and how therapeutic hypothermia in the post-arrest patient can make this diagnosis more challenging. Next up, Dr. Harrison taught us some pearls on management of the bradycardic peri-arrest patient. Dr. Nagle shared with a us how to rescuscitate a patient with acute aortic dissection. Lastly, Dr. Summers talked to us about PRES and how to recognize and treat this rare disorder.
Read MoreCommon Issues in Therapeutic Hypothermia
1) Bradycardia: may occur during induced hypothermia (even to as low as 35 bpm) and except in rare cases, is NOT a reason to discontinue hypothermia.
2) Dysrhythmias: generally does not occur unless temperatures fall < 30*C and hypothermia related ventricular fibrillation is rare unless temperature is < 28*C.
Read MoreIn last weeks Lessons in Transport we reviewed who should & should not receive therapeutic hypothermia post return of spontaneous circulation from cardiac arrest...
Here are the answers to the scenarios...
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To COOL or NOT To COOL that is the question...
(Read each of the following scenarios & honestly ask yourself if this is a patient suitable for therapeutic hypothermia)
Scenario 1: 67 yo male scene STEMI, witnessed Vfib arrest with ROSC, GCS 3T, stable vitals
Scenario 2: 24 yo female MVC, ejected, hypotensive for EMS, 10 minute cardiac arrest with ROSC, GCS 3T
Scenario 3: 2 yo female cardiac arrest suspected choking, ROSC after removing food from her airway. GCS 4T (1T2)
Read MoreSRU (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.
