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We cover pearls from smaccDUB (Social Media and Critical Care Conference in Dublin, Ireland), Day 2. We are here thanks to the Rosh Review.

Dr. Reuben Strayer (@emupdates) – “Disruption, Danger, and Droperidol: Emergency Management of the Agitated Patient”  

Dr. Strayer presented a brilliant talk on dealing with the quintessential Emergency Medicine patient – the undifferentiated acutely agitated patient. These patients are high risk and require emergent stabilization and resuscitation.  

• Oh, and, droperidol is not dangerous [1]. See this post on the controversial black box warning.

Dr. Haney Mallemat – “The PEA Paradox”

• The typical way we think about PEA, the “H’s and T’s,” is overly complicated. Further, we are horrendous at pulse palpation (see this for more) [2,3], and so what we think is PEA may not actually be PEA.  Dr. Mallemat proposed something along the lines of the following the following.

• For some FOAM commentary on the limitations of this approach, see this post by Dr. Rory Spiegel [4].

Dr. Michele Dominico – “How Usual Resuscitative Maneuvers Can Kill Paediatric Cardiac Patients”

Interventions we jump to in sick patients – oxygenation, ventilation, vasopressors – these can kill pediatric patients with cardiac pathology. She gave examples of some high yield pearls in these already terrifying patients.

EM Literature update by Drs. Ashley Shreves and Ryan Radecki

• Antibiotics for uncomplicated diverticulitis? May not be necessary
• Antibiotics for appendicitis? Maybe an option for some, but it may just be delaying an appendectomy.
• Tamsulosin for ureteral stones? Not necessarily indicated unless there are large (>5mm), distal stones.

 Ridiculous Research Pearls from Drs. Ashley Shreves and Ryan Radecki

• Perception of dyspnea and pulmonary function tests change with stress – and rollercoaster rides.  Rietveld S, van Beest I. Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception. Behaviour research and therapy. 45(5):977-87. 2007. [pubmed]
• Cured pork for epistaxis? Possibly. Researchers will try everything, especially if it involves bacon. Humphreys I, Saraiya S, Belenky W, Dworkin J. Nasal packing with strips of cured pork as treatment for uncontrollable epistaxis in a patient with Glanzmann thrombasthenia. The Annals of otology, rhinology, and laryngology. 120(11):732-6. 2011. [pubmed]

References:

1. Calver L, Page CB, Downes MA et al. The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Annals of Emergency Medicine. 66(3):230-238.e1. 2015. [article]
2. Tibballs J, Weeranatna C. The influence of time on the accuracy of healthcare personnel to diagnose paediatric cardiac arrest by pulse palpation. Resuscitation. 81(6):671-5. 2010. [pubmed]
3. Eberle B, Dick WF, Schneider T, Wisser G, Doetsch S, Tzanova I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation. 33(2):107-16. 1996. [pubmed]
4. Bergum D, Skjeflo GW, Nordseth T. ECG patterns in early pulseless electrical activity-Associations with aetiology and survival of in-hospital cardiac arrest. Resuscitation. 104:34-9. 2016.