Non-invasive ventilation is a great technique that we can use for just about any patient who is short of breath. We can use it to avoid intubation in our patients who are close to respiratory failure. In this episode, we’ll talk about how non-invasive ventilation works, which patients we can use it on, and how to actually make it happen. For that last part, I’ll borrow from a post by Seth Treuger at his blog mdaware.org on how to start non-invasive ventilation quickly while keeping it comfortable for the patient.
mdaware.org blog post- “Selling Ice Cream in the Desert” aka how to make NIV work on any patient
Sorry there was no episode posted this morning. My plan is to record it today and have it ready late Monday or early Tuesday. As a preview- the topic is non-invasive ventilation- a topic I have been promising for a while now!
Here’s what happened (if you care)- I am currently commuting back and forth from San Antonio to Fort Hood on the weekends (2+ hour drive). I was an hour out of Fort Hood on Friday when I realized that I forgot to pack up my microphone. So no dice on recording the episode on Sunday like I planned. Sunday night comes around and I am packing to go back to Hood, open my trunk, and what do I find but my microphone. As I said last night on twitter- #firstworldpodcastproblems
Have a great Monday
This episode will discuss the NEXUS study. NEXUS studied thousands of patients to validate a set of rules so that we can “clinically clear” patients with possible c-spine injury without getting an x-ray. This study has helped us avoid radiation in certain low-risk patients, saved the cost of x-rays and CT scans, and speed these patients through the ED. We’ll talk a lot about the statistical side of this study and how you can apply it in your everyday practice.
All right- let’s keep the laughter to a minimum…today’s episode is talking about how to approach testicular pain in the ED. You need to know how to approach this chief complaint because if you don’t workup the patient correctly, they can lose their future fertility and possibly their testicle. We’ll review how to take a good history and do a rapid focused exam to make sure that we catch all those patients with torsion and don’t delay their treatment.
This article was published recently in the Annals of Emergency Medicine and it is causing some clinicians to radically change their practice. The study looked at patients who are on oral anticoagulants such as coumadin (warfarin) who sustain minor head injuries. The study examined the value of admitting these patients for 24 hour observation with a repeat head CT at the 24 hour mark. The study found a small proportion of patients with delayed bleeding but how much should we care about this phenomenon? We see these patients a lot- is it worth the cost to admit all of them for observation and a repeat head CT? Read the article, listen to the podcast, and then decide for yourself.
Management of Minor Head Injury in Patients Receiving Oral Anticoagulant Therapy: A Prospective Study of a 24-Hour Observation Protocol
Vincenzo, et al. Annals of Emergency Medicine June 2012. 59(6) 451-455.