Scientific Assembly Day 2 Pearls
(there’s too much to choose from, so follow #ACEP14)
Simple Complaints in Patients with HIV – Dr. John Perkins
- HIV is a risk factor for coronary artery disease (CAD) and these patients are prone to thrombotic complications [Boccara et al]
- Dr. Amal Mattu has really championed this point, as in this videocast
Resuscitation Pearls – Dr. Scott Weingart
- REBOA and ECMO are exciting and coming…but most of us don’t have them. Watch the literature.
- “Normal” vital signs shouldn’t reassure us in trauma. Don’t wait for patients to become hypotensive (this is a danger of euboxia)
- The Shock Index (Heart Rate/Systolic Blood Pressure) is one way to help detect badness amongst “normal” vital signs in these patients (See this post)
- ACLS algorithms, they’re helpful for people who don’t specialize in resuscitation. Think about the individual patient and target interventions accordingly. Oh, and do good CPR.
- The AHA supports this, for example, they recommend against the routine use of calcium and sodium bicarbonate [2010 Guidelines].
End of Life/Palliative Care – Dr. James Adams
- Hospice and palliative care are INTENSIVE. Listen to Dr. Ashley Shreves on the EMCrit podcast if you’re not convinced of this (actually, listen regardless, it’s worth it).
- A Do Not Resuscitate (DNR) order only speaks to whether or not a patient wants CPR if they die. No more, no less. But, for more on this, check out this blog post.
- In general, physicians don’t broach end-of-life topics with patients. Dr. Adams quoted a statistic “Approximately 50% of doctors don’t know their patient’s resuscitation wishes.” The consensus in the room was that it really doesn’t take that much time to initiate these conversations but brief questions asking about a patient’s wishes, checking in to see if they have sufficient resources, or. (Lauren’s take on the topic).
The cliff notes, courtesy of Dr. Seth Trueger
Also, the first 5 from 2013: