#EMDutch Review – 2

3 Jun

A new month means….a new EMDutch Review. And it has been a great month on twitter. We have learned a lot and now it is time to share that knowledge with you! Here we go:


OA Critical Care: Lactate clearance as a target of therapy in sepsis: a flawed paradigm

Lactate metabolism and as a marker of metabolic stress. Patients with sepsis and an increased lactate do not have an oxygen debt and that increasing oxygen delivery will not increase oxygen consumption and that such an approach is unlikely to be beneficial and may be harmful. Furthermore, while a failure of blood lactate levels to decline after the initiation of treatment is an ominous sign, adequate lactate clearance does not guarantee survival.

(Lactate can also be caused just by exercise: http://pricelesselectricalactivity.blogspot.nl/2012/11/a-shocking-blood-gas.html?m=1 )

Academic Life in Emergency Medicine: PV Card: Contraindications to Thrombolytics in Stroke
Thrombolytic Contraindications for CVA based on the Stroke 2013 AHA/ASA new guidelines that were just published, with some changes.


Emergency Medicine Lit of Note: The EM Lit of Note PE Decision Tree
Why is this PE-tree different you think??? Well, you consider what kind of PE you would miss if you don’t go into the PE work-up! If it is not a “bad miss”…don’t do the work-up! (Like we said before on EMDutch: PE…not as deadly as we think)


PHARM: Use of Prehospital RSI predicts survivors after out of hospital cardiac arrest
As you probably know there have been prehospital studies suggesting that intubation causes a worst outcome in arrest patients. This paper refutes that assertion, saying that ”its not the intubation itself that is causing the worse outcomes, its the fact that if you can intubated a dead person without RSI drugs”.

The Chart Review: Aspirin, Plavix and Coumadin, Oh my!
We have to Investigate headaches in patients on antithrombotics aggressively. “ASA/Plavix > risk than coumadin but ASA/plavix/coumadin is very high risk.”

SCANCRIT.COM: Why The GCS has got to go
The GCS was never intended to be used in trauma and the AVPU is way easier!


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