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By Perry Lee, MD (PGY-3)
Advanced airway management is a mainstay of an emergency physician’s armamentarium. Many practitioners establish a routine with personal nuances established either by their training or from prior experiences. Here we examine common techniques and their effectiveness. The studies selected are not meant to drastically change your systematic practice, but give recognition to the variability in routine that can still achieve a successful intubation. In addition to technique, intubation success also relies on muscle memory from repetitive practice, operator confidence from successful mental visualization, and the ability to calmly troubleshoot a difficult airway.
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By Perry Lee, MD (PGY-3)
Tranexamic Acid (TXA) is an antifibrinolytic that inhibits the enzymatic breakdown of fibrin by plasmin.[i] It was first developed in 1962 by Japanese wife and husband researchers, hoping to find an effective treatment for post-partum hemorrhage which was a leading cause of maternal death in Japan at that time.[ii] Given its effectiveness and relative cheap cost, TXA has routinely been included on the World Health Organization’s List of Essential Medicines.[iii] Below is a list of uses for TXA commonly encountered in the emergency department (ED) with supporting research. By Emerson Posadas, MD, MBA PGY-3
The use of thrombolysis in the management of pulmonary embolism is controversial. While many physicians will give thrombolytics in patients with massive pulmonary embolism, I have found that many physicians are much more hesitant to utilize thrombolysis for sub-massive pulmonary embolism. While there has been significant evidence behind the use of thrombolysis in CVA and cardiac ischemia, the evidence behind its use in pulmonary embolism is much less clear. Yet, pulmonary embolism represents a significant disease process that is associated with high morbidity and mortality. The AHA and American Cardiology Association in the past year has advocated for the use of thrombolytics in both massive and sub-massive pulmonary embolism in select patients.1However, ACEP has yet to release a clinical policy regarding the use of thrombolysis in sub-massive pulmonary embolism. In this review, I will discuss the evidence behind the use of thrombolysis in pulmonary embolism, specifically in sub-massive pulmonary embolism. By Emerson Posadas, MD, MBA (PGY-3)
Thromboelastography (TEG) is a tool that measures in real-time clot development, stability, and dissolution. It not only measures the coagulation cascade, but also shows the interaction of platelets in clot formation. It is a dynamic measurement, that has in recent years, become more readily available in the emergency department. This blog will review the evidence behind its use in the Emergency Department in the setting of shock in both trauma and medical patients. |
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June 2022
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