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Showing posts from April, 2017

Pediatric Airway Management in the Emergency Department

Pediatric endotracheal intubation is an uncommon procedure in the Emergency Department (ED); even in high volume tertiary pediatric centres the incidence has been reported at 8-10/10,000 patients. While infrequent, pediatric airway management is an essential and life-saving skill that all ER physicians must be prepared for.  Much of the knowledge and skill set from the adult world is applicable here, however there are several important differences that are unique to the pediatric population.

Effect of Noninvasive Ventilation Delivered by Helmet vs. Facemask on the Rate of Endotracheal Intubation in Patients with Acute Respiratory Distress Syndrome

SummaryMethodology Score: 4/5
Usefulness Score: 3.5/5

Patel BK, et al. JAMA. 2016 Jun 14;315(22):2435-41
Full Article

Editorial: Unmasking a Role for Noninvasive Ventilation in Early Acute Respiratory Distress Syndrome. Beitler JR, et al. JAMA. 2016 Jun 14;315(22):2401-3.

This single-centre, non-blinded RCT of ICU ARDS patients, found that NIV delivered by a novel helmet, as compared to a standard NIV facemask, reduced intubations (18.2% vs. 61.5%; P <0.001) and hospital mortality (27.3% vs. 48.7%; P= 0.04). Despite its few methodological flaws, this study supports the existing literature on the advantage of oxygen delivered via helmet over facemask in avoiding intubation in ARDS, and future studies should focus on its impact in heart failure or hypercapneic respiratory failure.
By: Dr. Shannon Fernando 
Epi lesson:
Interim Analyses and Stopping Rules
In clinical trials, an interim analysis is one that is conducted before data collection has been completed to determin…

Focus on POCUS: Subacute, Progressive Dyspnea while Swimming

A male in his 60’s presents with progressive dyspnea on exertion x 1 month starting while he was swimming in the ocean. He had not been diving.  He has no significant medical history and takes no medications.

Diagnosis of Acute Cardiogenic Pulmonary Edema (ACPE) with Point-of-Care Ultrasound

Point-of-Care Ultrasonography (POCUS) is a valuable tool in the diagnostic armamentarium of the emergency physician. We have been successfully using it to the place lines, diagnose AAAs and assess the cardiac function of our dyspnea patients for awhile now. But what about the lungs? Typically air is thought of as the enemy of ultrasound, but can we successfully use it to diagnose acute respiratory conditions despite this? In this Grand Rounds review, Dr. Elizabeth Lalande goes through the use of POCUS in the diagnosis of Acute Cardiogenic Pulmonary Edema in the undifferentiated, dyspneic patient.