Lactate for Safely Screening Sepsis?

Fernando et. al. HELPFUL ONLY WHEN ELEVATED: INITIAL SERUM LACTATE IN STABLE EMERGENCY DEPARTMENT PATIENTS WITH SEPSIS IS SPECIFIC, BUT NOT SENSITIVE FOR FUTURE DETERIORATION Journal of Emergency Medicine, Vol. 54, No. 6, pp. 766–773. https://doi.org/10.1016/j.jemermed.2018.01.040 BOTTOM LINE: A lactate >4 in this prospective observational cohort study of almost 1000 patients with the “CMS” definition […]

To B (VM) or Not to B (VM) THAT is the question!

Source: Casey et. al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. NEJM. February 18, 2019DOI: 10.1056/NEJMoa1812405 Whether ‘tis noble in the mind to suffer the slings and arrows of aspiration or by bagging end them? This is a great methodological (and probably landmark) trial by the impressive authors at Vanderbuilt et al. They have been […]

SUP-ICU Trial: Pantoprazole in patients at risk for Gastrointestinal Bleeding

SUP-ICU Trial Kart, M. Pantoprazole in patients at risk for Gastrointestinal Bleeding in the ICU. N Engl J Med 2018;379:2199-208. Trial done in the UK. It was a multicenter, stratified, parallel group, placebo controlled blinded randomized trial. Included pts admitted to the ICU who were 18 yo or older and had at least one risk […]

HYPONATREMIA 2.0

HYPONATREMIA PART I – TREATMENT RECOMMENDATIONS IN CASE OF HEMODYNAMIC INSTABILITY, THE NEED FOR RAPID FLUID RESUSCITATION OVERRIDES THE RISK OF AN OVERLY RAPID INCREASE IN SERUM SODIUM CONCENTRATION. TREATMENT GOALS: An increase by 4-6-mmol/L [Na] is sufficient to reverse most serious manifestations of acute hyponatremia. Increase [Na] no more than 10 mEq/L in 24 hour […]

QUICK HIT #11: WHAT TIDAL VOLUME SHOULD BE STARTED IN PATIENTS WITHOUT ARDS

QUICK HIT ARTICLE Effect of a Low vs. Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS: A Randomized Clinical Trial. Writing Group for the PReVENT Investigators . Simonis. JAMA. 2018; 320(18):1872-1880 All right pop quiz, hotshot. Altered patient gets intubated in the ED. He’s almost to the ICU. The RT asks […]

Quick Hit Article #9: Thiamine for severe sepsis? Yes, No and Maybe?

Today’s quick hit article is probably the first in a long list of articles to come looking at Thiamine, vitamin C, or steroids for septic shock. Woolum. Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock. Critical Care Medicine 2018. Bottom Line: When compared in a chart review, patients with […]

Hyper K, The EBM Way: Protect, Push, and Purge

As we all know hyperkalemia is a life threatening condition. But how can something so basic be shrouded in such confusion? So many choices and everyone has their own recipe to fix it. Along with all the treatment choices, come pitfalls and side effects. Thus, we need to know what is the best way to […]

(Really) Quick Hit Article #7 – LR does not clinically increase serum lactate. If you believe in lactate…come along with me…

Source: J Emerg Med. 2018 Jul 20. pii: S0736-4679(18)30602-4 Today’s (really) quick hit is a neat little article trying to answer the question “Does Lactated Ringers increase your serum lactic acid. Given that sepsis seems to be the only diagnosis of anymore, can our friend lactic acid still help us if we are giving 30 ml/kg […]

Quick Hit Article #6: How much insulin to give ESRD patients with Hyper K?

One of the most physiologically complicated yet overly simplified “set it and forget it” protocols in emergency medicine just might be the acute treatment of hyperkalemia. We all have the protocol in our head and can write it up in our sleep (hopefully) but how effective is it? How safe is it? How evidenced based […]

Quick Hit Article #5: Epi in cardiac arrest – Saving the heart! Saving the brain?

The long awaited (you were all waiting for it right?) PARAMEDIC2 trial for epinephrine in “out of hospital cardiac arrest” (OHCA) is finally here from the UK. We all know and love epi. We give it every 2-5 minutes in codes but why are we doing it? How well does it help us in return […]