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US Probe: Assessing Venous Congestion – The VExUS Approach

EMDocs

1 Even beyond the assessment of volume tolerance, there is suggestion that the VEXUS scan can be used to guide decongestion from heart failure, 2 guide the decision for dialysis 3 , and identify different venous congestion as it mimics different pathologic states such as cardiogenic shock or cholecystitis. 2020;12(1):16.

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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. Xylazine withdrawal is controversial.

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Push-Dose Pressors in the Emergency Department

ACEP Now

My goal in this column is to share tips, tricks, and emerging concepts from the intensive care unit (ICU) that you can use on your next shift in the emergency department (ED). 1 Push-dose pressors can come in handy in three situations: Anticipated transient hypotension. What is a Push-Dose Pressor? Epinephrine (“epi”).

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emDOCs Revamp: Alcohol Withdrawal

EMDocs

Initial vital signs: HR 136 BPM, BP 172/82 mmHg, RR 24, T 37.2C, SpO2 97% RA Physical examination: General: restless, mildly agitated CV: tachycardic, regularly regular, diaphoretic, Abdomen: Soft, NT, ND, intermittently dry heaving Neuro: tremulous in bilateral arms and hands, tongue fasciculations What do you suspect as the diagnosis?

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Is Pip-Tazo Harming Sepsis Patients?

REBEL EM

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%). 9 Instrumental Variable Analysis? vs. 52.2%).

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ED care of refugee populations from sub-Saharan Africa

EMDocs

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. g/dL, thrombocytopenia of 96 10 9 /L, prothrombin time (PT) of 16.1 1 By the end of 2023, 117.3 million people had been forcibly displaced, representing 1 in 69 individuals or 1.5% seconds (normal 30-40 seconds), creatinine of 3.11

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emDOCs Podcast – Episode 123: Sympathetic Crashing Acute Pulmonary Edema

EMDocs

SCAPE defining features: 1) rapid onset of respiratory distress (<4-6 hours); 2) pulmonary edema with severe dyspnea; 3) abdominal vital signs with SBP > 160 and/or > 120, hypoxic, tachypneic, tachycardic; 4) critically ill, evidence of pulmonary edema. Lower intubation, need for BPAP and ICU admission in bolus group (Levy 2007).

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