Comments for Emergency medicine podcasts, reviews and curbside consults Sat, 25 Jul 2015 10:42:18 +0000 hourly 1 Comment on The Subarachnoid Enigma by Ran Sat, 25 Jul 2015 10:42:18 +0000 There are no studies powered to answer this question. But I think the answer lies in what is done when there is a positive CT or LP for SAH. The next step for most neurosurgeons is a digital subtraction angiography, which is the gold standard for vessel imaging. If DSA is negative, it is repeated in 1-2 weeks.

Wait a minute: why repeat a gold standard test?

In the context of an acute bleed, vessel imaging tests become unreliable because there can be vasospasm of the aneurysm to sizes that cannot be detected by DSA, much less CTA. Some textbooks cite 22% false negative rate for DSA in context of acute bleed but I can’t find studies. For this reason, DSA is repeated 1-2 weeks later preferably when the patient is without headache and thus, presumed to no longer have vasospasm.

Thus if DSA cannot exclude aneurysm in patients with WOHL, I do not think CTA can be relied upon either.

Comment on Pediatric C-spine Clearance by Rob Orman Sun, 12 Jul 2015 21:04:05 +0000 Here’s the reply from Andy Sloas…

Quick two view xr and leave the collar off.
Tx the torticollis

Comment on Pediatric C-spine Clearance by Ralph Knorr Sun, 12 Jul 2015 07:17:59 +0000 What about placing a collar on a child with torticollis or positional discomfort?
When placing a collar will cause pain/distress.

Comment on Anticoagulation Reversal by Rob Orman Sun, 28 Jun 2015 18:24:53 +0000 Hey Araja,
What’s the context of the question/clinical setting?

Comment on Splint like a pro by Rob Orman Sun, 28 Jun 2015 18:23:53 +0000 Hey Sathya,
No plans for a radial gutter video. It’s a splint I struggle with as well. Whenever I make one, it looks like a plaster monster!

Comment on Splint like a pro by Sathya Fri, 26 Jun 2015 04:37:58 +0000 Hey I’m a Peds EM fellow and have been using your videos to teach myself how to split. Your videos are the best on all the internet. I’d really like to know how to do a radial gutter splint. Is this something you would be able to show all your viewers?

Comment on Anticoagulation Reversal by Ajara Bhattarai Tue, 16 Jun 2015 03:09:11 +0000 If in case vitamin K is not available which would be the drug of choice???

Comment on PEA made simple by clay josephy Fri, 12 Jun 2015 10:08:31 +0000 SO i think this makes great sense, and the fact that pts in PEA often may just be in cardiogenic shock for one reason or another.

But what do you do about it? I hear you guys saying that “this patient doesn’t need chest compressions they need treatment for their pump failure”

I had this case last night. PEA arrest, coded in front of me at arrival first rhythm disorganized wide complex PEA with a right bundle pattern. ACLS, chest compression, Ca/HC03, IVFs, EPI and got ROSC. 12 lead done, RBB, tacky. maybe PE? Intubated, had pulses, perfusing, and I was going to fly her to the PCI/tertiaryhospital. But, then lost pulses again. But did she???

Short is her ETc02 was 25 with no compressions! 45 with CPR…so she has some CO, but we couldn’t get a BP, I couldn’t feel pulses, so i maximized pressors, EPI, and added levo..even gave her bolus vasopressin, no effect on BP. But i knew she had some CO because she was perfusing her lungs (ETC02>20) and she had some output on her ECHO which looked like a dying heart. So, i just gave her lytics, but that didn’t help either.

Quesiton: Do you continue compressions here? Vasopressor/inotropy refractory shock with no palpable pulse (i.e.. the player previously known as PEA?)

I didn’t get an a-line in, but that may have been helpful. But when do you stop doing compressions? I have no idea.

Comment on Scott Weingart on the State of Things by Podcast 150 - A Look Back Tue, 02 Jun 2015 16:25:38 +0000 […] or listen at ERCast […]

Comment on Amal Mattu on Low Risk Chest Pain by SK Mon, 01 Jun 2015 08:54:00 +0000 Thanks Rob and Amal.
fantastic podcast.
Despite all these years of experience i always found dealing with non specific chest pain very frustrating.
This scoring system makes life so much easier if used properly.
As Rich Levitan says this is the Ahaa moment- for chest pain patients.
i think a scoring system like this for chest pain was long overdue.
thanks once again.