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References:

1. Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, Bynum J, Long B. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021 Mar;41:104-109. doi: 10.1016/j.ajem.2020.12.065. Epub 2020 Dec 28. PMID: 33421674.
2. Giancarelli A, Birrer KL, Alban RF, Hobbs BP, Liu-DeRyke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. 2016 May 1;202(1):182-7. doi: 10.1016/j.jss.2015.12.036. Epub 2015 Dec 30. PMID: 27083965.
3. Webster S, Todd S, Redhead J, Wright C. Ionised calcium levels in major trauma patients who received blood in the Emergency Department. Emerg Med J. 2016 Aug;33(8):569-72. doi: 10.1136/emermed-2015-205096. Epub 2016 Feb 4. PMID: 26848163.

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This episode is a departure from the typical FOAMcast clinical content, we will be back with strictly clinical content soon.

In May 2022, I came across a fellow passenger and stranger in cardiac arrest at the Charlotte airport. A small team of strangers, including an emergency medicine resident, Dr. Jason Tanner, and an emergency department technician, Angel, assembled to treat this passenger. Billy Frolick, a writer and our patient that day shares his perspective on his case with us. This story is a reminder of the importance of continuous chest compressions, early defibrillation, and that what we do in emergency and prehospital medicine matters. For more on why we should, in accordance with guidelines, abandon routine pulse checks, see this podcast: https://foamcast.org/2022/09/04/pulse-checks-during-cardiopulmonary-resuscitation/ or this article: https://www.acepnow.com/article/stop-performing-routine-pulse-checks-during-cpr/

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This episode covers the 2022 American College of Emergency Physicians (ACEP) clinical policy on acute heart failure syndromes with a special focus on high-dose nitrates The 2007 ACEP clinical policy can be found here.

References:

1. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Heart Failure Syndromes. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Heart Failure Syndromes: Approved by ACEP Board of Directors, June 23, 2022. Ann Emerg Med. 2022 Oct;80(4):e31-e59. doi: 10.1016/j.annemergmed.2022.05.027. PMID: 36153055.
2. Silvers SM, Howell JM, Kosowsky JM, Rokos IC, Jagoda AS; American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes. Ann Emerg Med. 2007 May;49(5):627-69. doi: 10.1016/j.annemergmed.2006.10.024. Epub 2007 Apr 3. Erratum in: Ann Emerg Med. 2010 Jan;55(1):16. PMID: 17408803.
3. Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, Dunne R, Zalenski R. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007 Aug;50(2):144-52. doi: 10.1016/j.annemergmed.2007.02.022. Epub 2007 May 23. PMID: 17509731.
4. Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, Shaham O, Marghitay D, Koren M, Blatt A, Moshkovitz Y, Zaidenstein R, Golik A. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998 Feb 7;351(9100):389-93. doi: 10.1016/S0140-6736(97)08417-1. PMID: 9482291.
5. Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017 Jan;35(1):126-131. doi: 10.1016/j.ajem.2016.10.038. Epub 2016 Oct 18. PMID: 27825693.
6. Wang K, Samai K. Role of high-dose intravenous nitrates in hypertensive acute heart failure. Am J Emerg Med. 2020 Jan;38(1):132-137. doi: 10.1016/j.ajem.2019.06.046. Epub 2019 Jun 25. PMID: 31327485.
7. Perlmutter MC, Cohen MW, Stratton NS, Conterato M. Prehospital Treatment of Acute Pulmonary Edema with Intravenous Bolus and Infusion Nitroglycerin. Prehosp Disaster Med. 2020 Dec;35(6):663-668. doi: 10.1017/S1049023X20001193. Epub 2020 Oct 7. PMID: 33023684.

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In this episode, we review the largest trial of double sequential external defibrillation (DSED) and vector change (VC) defibrillation for refractory ventricular fibrillation (VFib): Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022;387(21):1947-1956.

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Since 2010, the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) have recommended against routine pulse checks during CPR. More than a decade has elapsed since this time, yet many people are continuing to perform pulse checks every couple of minutes during CPR. In this episode, and in this ACEPnow article, we discuss the literature around this.

Cummins RO, Hazinski MF. Cardiopulmonary resuscitation techniques and instruction: When does evidence justify revision? Ann Emerg Med. 1999;34(6):780–784.

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There are practice-changing updates in the guidelines from the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST), found here. In this podcast, we review hemorrhoids and management.

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In this podcast, we review acute urticaria (<6 weeks in duration). We review the recent international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria (Zuberbier et al) In addition, we review some of the controversy regarding the administration of steroids for acute urticaria.