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Time for another fun filled month of EM:RAP and this time we start with ACEP's procedural sedation guidelines. Like Mel they are short and to the point. Also some general education loveliness in the form of Sir Ernest Shackleton, yep not just a medical education program but an audio series to make you a better and smarter person....you're welcome!
Joseph A. H. - May 12, 2014 2:22 PM
even mare amazing about shakelton is that their navigation on the sail from the weddell sea to south Georgia was by sextant sights. which is almost impossible from a small boat even on a good day.
these were amazing guys.
you also left out that they survived by eating their sled dogs.
Josh K. - May 13, 2014 2:35 PM
Hey Joseph, thanks for commenting! There are so many unbelievable aspects of this story that we could not fit them all into 2 minutes; we had to leave out the eating of the sled dogs as you mentioned but also we didn’t talk about what it was like for the men left on elephant island waiting for Shackleton’s return (imagine not knowing whether anyone was coming to get you for 4 months…that in and of itself is a great psychology of survival story). Also, we didn’t mention that in order for Worsely to even make sextant readings on the 4 occasions that they had clear enough skies, two other guys had to lift him up on their shoulders so he could see the horizon. Too many good parts…not enough time! Thanks for listening!
James G. - May 25, 2014 1:05 PM
I love the idea of putting in an intraosseos device instead of a central line. A search of the literature shows me that in critically ill patients is it faster and more likely to be successful (below) - however I couldn't find very much to support it's use in alert but generally sick patients (that wasn't protected by a pay wall). Could you direct me to such evidence? Also I know you can put an adrenaline infusion into the IO but how quickly does it have it's effects? Could you titrate up and down according to response?
Comparison of intraosseous versus central venous vascular access in adults under
resuscitation in the emergency department with inaccessible peripheral veins Bernd A. Leidela,c,∗, Chlodwig Kirchhoffb, Viktoria Bognerb, Volker Braunsteinb,
Peter Biberthalerb, Karl-Georg Kanzb
Michelle S., PA-C - June 7, 2014 4:49 PM
Strangely enough, every time I listen to EM RAP in route to the ER, I manage to have some form of a patient from the podcast show up in my ER that night.
This episode I had a patient come in who was awake, alert but clearly needed IV fluids. I am a solo provider in a rural ER with one nurse. My nurse was not able to start and IV on this patient. None of the nurses from the floor could start an IV. They wanted me to ship this patient to a larger ER, 45 min away for IV fluids. (I don't do central lines and my back up docs are even less likely to do a central line) I decided an IO was a perfect choice to get some fluids in this patient. The nursing staff thought I had been smoking something on my way to this shift. Started the IO. After a few liters of fluids, her veins popped right up and we were able to start a peripheral IV.
I thought I was pretty cool and the nursing staff still think that I am a bit nuts.