Start Peripheral Vasopressors Early in Shock!
It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line.  However, available evidence doesn’t support this. Diluted solutions of all catecholamines are safe (except Vasopressin) to be administered peripherally via a well functioning 18-20G IV or larger in forearm (no hand/wrist/AC) . No old IVs (>72 hrs) Know how […]
Treating Hyperkalaemia
Know Your IV Fluids
Ketamine… your best friend in the ED
The ability of ketamine to produce dissociation is of great value to clinicians who perform painful procedures in general emergency medicine
The Recovery Trial: Effect of Dexamethasone in Hospitalized Patients with COVID-19 – Preliminary Report
The findings of this well done randomized controlled trial indicate that in patients with COVID-19 pneumonia, that dexamethasone improves 28d mortality compared to placebo in patients requiring invasive mechanical ventilation (IMV) (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29).
Giving adenosine for SVT
Giving adenosine 6mg in 20mL of saline as a single syringe push vs the usual 6mg push and rapid flush with 20mL saline is non-inferior for the treatment of SVT.
NSAIDS increase risk of Heart Attacks
A cohort of 446 763 individuals including 61 460 with acute myocardial infarction was acquired. Taking any dose of NSAIDs for one week, one month or more than a month was associated with an increased risk of myocardial infarction. With use for one to seven days, the probability of increased myocardial infarction risk (posterior probability […]
Local Anaesthesia Toxicity (LAST)
The key in managing LAST is prevention. Know your dose, know your maximum dose, always aspirate prior to injection and ask patient about symptoms Lidocaine toxicity cardiovascular complications are typically preceded by neurological signs/symptoms. If these develop, stop administration, place patient on monitor and ready your antidote Bupivacaine toxicity can be sudden and catastrophic. If […]
Analgesia in Polytrauma
Rapid Sequence Intubation Medications
Induction Agents Medication Weight-Based Dosing Time to Onset of Action Adverse Effects/ Contraindications Etomidate 0.3 mg/kg <1 minute May cause clinically insignificant adrenal suppression. Ketamine 1-2 mg/kg 1-3 minutes May increase blood pressure. May cause hypersalivation. Propofol 2 mg/kg <1 minute May cause hypotension. Cardiac depressant. Contraindicated in egg/soybean allergy Midazolam 0.3 mg/kg 1-5 minutes […]
