New Zealand National Poisons Centre consultations about antidotes to treat poisonings
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#MedSky #EMSky #EMedSky #emimcc #ACEM
@emajournal.bsky.social
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@emswami.bsky.socialBest way to improve outcomes in cardiac arrest is w/ early defib + high-quality CPR
-Key: max your compression fraction
-Poor defib coordination can eat at hands on time
-Precharging defib reduces hands off time + incr compression fraction ➡️ improved rate of ROSC
@imcrit.bsky.social
@olofl-s.bsky.social@emswami.bsky.socialCremasteric Reflex in testicular torsion
-Sensitivity ranges from 21-100% (PMID: 40537283)
-Clearly, inadequate to rule out the diagnosis of torsion
@emswami.bsky.socialOptimal ETT Shape w/ standard geometry blade (DL or VL) is 25-35 degrees (PMID: 17079788)
-Straight to cuff w/ 25-35 degree angulation
-Anything beyond that increased the risk of difficult or impossible tube delivery
@load-dependent.eurosky.socialWhy the increased thrombotic events? Less use of antithrombotics/anticoagulants? #emimcc #critcaresky
@imcrit.bsky.social@emajournal.bsky.socialAn Embedded Low-Acuity Pathway Should Be Judged Beyond Throughput
#LetterToTheEditor
@emajournal.bsky.social
@emswami.bsky.socialABIs in Extremity Trauma
-Normal ABI greater than 1.0. ABI less than 1.0 should prompt immediate surgical evaluation + CT Angio
-Critical part of evaluation. If abnormal should prompt rapid evaluation by surgery + CTA
@rebel-em.bsky.social📉 Does trending biomarkers help stop antibiotics sooner safely in sepsis?
👀 More here: https://wp.me/pdrP8b-5mL
@rebel-em.bsky.social🫁 Confused about hypoxia vs hypoxemia?
We’ve got a simple bedside approach‼️
🚫 Shunt ≠ Dead space
💡 Know when FiO₂ fails & PPV saves
🔗 https://loom.ly/hJFaydE
@imcrit.bsky.social@load-dependent.eurosky.socialMichel Slama showing that higher heart rate is correlated to increased mortality in sepsis, strongly believing there is benefit in reducing it with bet blockade. Running another landiolol trial to test it #emimcc
@emswami.bsky.socialCalcium doesn’t stabilize cardiac myocytes in hyperK
-Ca restores Ca dependent propagation
-Doesn’t matter clinically as Ca2+ will reverse hyperK induced ECG changes
-Ca2+ is still the treatment of choice in hyperK w/ significant ECG changes like QRS widening
@load-dependent.eurosky.socialI think this is turned upside down. There’s no reason to think the single center studies are credible, and try to find out what went wrong in the multi-center studies. Rather, the question is how the single center studies could be so consistently wrong. #emimcc
![What is known
Tachycardia is a feature of compensatory sympathetic stimulation (9, 10]. Sustained non-compensatory tachycardia may impair diastolic function, increase myocardial workload, and worsen ventriculo-arterial coupling [12-14). The potential to attenuate adrenergic toxicity while simultaneously allowing a compensatory adr-energic response has generated interest in the role of B-blockers. However, clinical studies have produced conflicting results [15-21]. In two multicentre randomised controlled trials (RTs) in septic shock, landiolol was associated with either an increased norepinephrine requirement and mortality (STRESS-L) [20] or no significant difference in vasopressor dose or mortality (Landi-SEP) [18]. These findings contrast with single-centre studies in which esmolol therapy was associated with reduced catecholamine requirements, fewer episodes of tachyarrhythmias, and improved mortality despite a significantly greater reduction in systemic oxygen delivery compared to the control group [21].
A limitation in some multicentre studies may have been the limited use of advanced hemodynamic monitoring capable of identifying clinically significant reductions in cardiac output and oxygen delivery after heart rate reduction [21, 22]. Moreover, a reduction of myocardial contractility may occur, but can pass undetected by conventional echocardiographic parameters 22).](https://cdn.bsky.app/img/feed_fullsize/plain/did:plc:wl5zwdwkg4kqg25gtxbepfh4/bafkreieqzwz264c7xezcqtlkgkuxmmenw4wearv2irat7qacpvk5kw36ha@jpeg)
@olofl-s.bsky.social