1. You local fire department responded to an incident at the courthouse where about ¼ teaspoon of white powder spilled from an envelope that contained payment for a parking ticket. What level of decontamination is required for the person handling the letter and those in the room? A. No decontamination. B. Soap and water wash of hands and areas where powder contaminated. C. Soap and water wash of everyone in the room. D. Quarantine the entire building and burn it to prevent spread.
Preventing sternal wound infections in the post operative cardiac surgery patient is an important aspect of post operative care. Sternal infections can increase length of stay, be a substantial financial impact, and increase mortality' Occurrence of sternal infections is rare and it has been reported as 0.4–4%. Managing hyperglycemia post-operatively has been one intervention implemented to make a significant impact on reducing sternal infections. It is for this reason we manage such glucose con
The placement and maintenance of central venous catheters (CVC), have received a great deal attention with the goal of minimizing iatrogenic injury to the patient and reduction in the occurrence of catheter related infections. Once the need for the catheter is done, careful attention to removal of the line is still needed to prevent complications for the patient such as bleeding, infection, air embolism, and catheter embolism. Key elements of this practice include knowledge of how an air embolis
This is my first official contribution to Resus Review. I wanted to start with a follow up on my recent comment on cardiac troponin. Cardiac biomarkers, particularly troponin, have become an essential tool in the work up of patients with symptoms suggestive of ischemia in which an "ACS" work up is required. At our hospital, just last week we had an interesting debate organized by the EM/IM department on troponin. We had very nice group of people discussing, including Steve Smith from the ECG blo
Its important to understand that in the US the FDA has not yet approved the high-sensitivity (hs) troponin assays. Therefore we are still talking about the so-called contemporary troponin assays. The current assay is a good test, and the high-sensitivity troponin will have even better from an analytical perspective at lower values. In either case the “differential” is not as important as WHEN to order it. With increased sensitivity (primarily when hs assays are here) there will be more positive
Airway pressure release ventilation (APRV) mode of mechanical ventilation is an elevated CPAP level with timed pressure releases. This mode allows for spontaneous breathing, and is especially useful for patients with ARDS, pneumonia, or trauma.
Some of the newest shortages that physicians are facing is droperidol and atropine. At my institution droperidol is widely used (over 900 doses per month) for treatment of acute migrainous headaches, antiemetic, and agitation. Atropine is a nonselective muscarinic acetylcholinergic antagonist and has uses in the treatment of bradycardia, hypersalivation, bronchoscontroctopn, and organophosphate poisoning. Below we have discuss some alternatives to these shortages.
Without notice even the smallest EDs can be thrust into the limelight after a disaster. As a physician leader, handling public relations represents its own challenge during a time of crisis. We will share with you some simple tips and precautions of dealing with the media after a mass casualty situation.
The flipped classroom concept allows learners to acquire the basic information outside of class to allow active learning during conference periods. This knowledge application time should clarify concepts, make decisions, and see consequences.
The evidence is accumulating that hyperthermia following severe traumatic brain injury (TBI) occurs frequently and worsens neurological outcomes. An interesting paper, Neurocrit Care. 2009;11(1):82-7, showed improved neurological incomes in patients who maintained normothermia. Based on this, our institution has developed a protocol for use in our neurocritical care patients to maintain normothermia.
I have tired of treating my ultrasound exam of a patient as separate from my physical exam. In the emergency department and ICU where I practice, ultrasound is much more than an adjunct, it is an integral part of my evaluation of the patient. The JAMA series on Rational Clinical Examination has taught us that each physical exam maneuver needs to be evaluated with an evidenced-based assessment, that includes sensitivity and specificity. We have learned through the series that many specific exams
I am finishing up residency after 5 years, and finally took the time to visit the Hennepin Medical History Museum. It is truly a fascinating place where you can see the evolution of medicine literally before your own eyes. I was particularly intrigued by the iron lung which was the mainstay of polio treatment, and the role Australian-borne nurse Sister Kenny played, when she eventually settled in Minneapolis.