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August 2015 Introduction

Rob Orman, MD and Anand Swaminathan, MD FAAEM
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13:21
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Nurses Edition Commentary

Mizuho Spangler, DO, Kathy Garvin, RN, and Lisa Chavez, RN
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00:06

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Tag Trauma
EM:RAP 2015 August Summary 1 MB - PDF

August brings part four of our conversation with Dr. Cam Berg on how his hospital standardizes, optimizes, and improves care of common conditions. This time, it’s the leviathan: SEPSIS. Reuben Strayer gives lessons hard learned from QA, while our in house pharmacologist Bryan Hayes gives the final word on which agent is better for A. Fib rate control. Amal Mattu is back with a cardiology corner on the scoundrel of cardiothoracic life threats: aortic dissection. Weingart dissects a complex case of post ROSC airway management and paper chase digs deep into blunt trauma thoracotomy. Annals of EM, LIN sessions, clinical sobriety and so much more!

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Karl T., M.D. -

ok, so the intro talks a lot about getting an MRI after a normal CT of the c-spine. Didn't we just have a paper in the July issue that said MRI wasn't needed if CT was normal?

Anand S., M.D. -

Karl - thanks for bringing this up. Definitely a lot of room for confusion here.
The EAST trauma guidelines discussed in the July paper chase recommend consideration for clearing the C-spine after a negative non-contrast c-spine CT in obtunded trauma patients. I think this has been standard care for a lot of trauma guys for the last couple of years. The issue is that transporting obtunded patients to MRI is wrought with hazards and leaving a patient who is intubated + not moving around in a c-collar is bad for ICP and pressure sores.
In awake, neuro intact patients with negative CT c-spine but continued midline tenderness, the recommendation remains to either get flexion-extension films (not in the emergent setting, usually 1-2 weeks after injury) or an MRI or simply home in a c-collar for delayed re-evaluation.

Evan M., M.D. -

Rob- Are you sure you have the definitions correct in your Sepsis Decision pathway? It was my understanding that Severe Sepsis is lactate >2 (above laboratory normal) and that lactate >4 seems to represent a "worser" severe sepsis. Have a look at up to date and the NQF.

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Quality Review Gets Septic Full episode audio for MD edition 252:40 min - 352 MB - M4AEM:RAP 2015 Août Résumé en Francais Français 62:21 min - 57 MB - MP3EM:RAP 2015 August Canadian Edition Canadian 31:42 min - 29 MB - MP3EM:RAP 2015 August Aussie Edition Australian 58:17 min - 53 MB - MP3EM:RAP 2015 Agosto Resumen Español Español 76:59 min - 71 MB - MP3EM:RAP 2015 August MP3 306 MB - ZIPEM:RAP 2015 August Summary 1 MB - PDFEM:RAP Español Agosto 2015 2 MB - PDFEM:RAP 2015 August Board Review Questions 223 KB - PDFEM:RAP 2015 August Board Review Answers 239 KB - PDF

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