Quantitative Acid-Base: A Simplified Approach for the Emergency Physician.

Background: A deep understanding regarding acid-base physiology has been generally absent from what is considered the skill set of Emergency clinicians. The calculations needed to obtain a solid comprehension of acid-base are thought to be too complex and time consuming, making them impractical for the chaotic environment of the Emergency Department.

Objectives: Make acid-base more approachable and accessible for the Emergency Physician.

Interprofessional Clinician Perspectives on LVAD Deactivation Compared to Dialysis Discontinuation: A Cross-Sectional Study Using Vignettes.

Background: Requests for left ventricular assist device (LVAD) deactivation may pose unique emotional and moral burdens on clinicians.

Objectives: The authors aimed to explore the perspectives of interprofessional clinicians regarding LVAD deactivation across clinical settings compared to cessation of hemodialysis.

Methods: Vignette-based interviews were conducted with a sample of interprofessional clinicians at a heart and vascular center from April 14, 2023, to June 5, 2023.

Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation.

The resuscitation of a patient in shock is a highly complex endeavor that should go beyond normalizing mean arterial pressure and protocolized fluid loading. We propose a holistic, four-interface conceptual model of shock that we believe can benefit both clinicians at the bedside and researchers. The four circulatory interfaces whose uncoupling results in shock are as follows: the left ventricle to arterial, the arterial to capillary, the capillary to venular, and finally the right ventricle to pulmonary artery.

Defibrillator Lead Perforation Leading to Concerning Electrocardiogram Findings: Case Report.

Introduction: Implantable cardioverter-defibrillator (ICD) lead perforation through the myocardium may result in chest pain and electrocardiogram (ECG) changes concerning for ST-segment elevation myocardial infarction. The clinical context of the ECG aids in appropriate management.

Case Report: We report the case of a 71-year-old woman experiencing chest pain after an ICD placement two weeks earlier.

The empty code cart: Drug shortages over time.

Purpose: In high-acuity situations such as cardiac arrest, clinicians rely on prepared medications stocked in code carts to provide timely and accurate pharmacotherapy. We examined shortage trends for medications commonly used in code carts.

Methods: Drug shortage data from 2001 to 2022 were retrieved from the University of Utah Drug Information Service (UUDIS) to characterize shortages reported for commonly used code cart medications.

In Vitro Treatment of Extracorporeal Membrane Oxygenation Coagulopathy with Recombinant von Willebrand Factor or Lyophilized Platelets.

Objectives: The objective was to compare primary hemostasis between adult ECMO patients and cardiac surgical patients before heparinization and cardiopulmonary bypass. Furthermore, the authors explored whether in vitro treatment of ECMO patient blood samples with recombinant von Willebrand Factor (vWF) or lyophilized platelets improved primary hemostasis in vitro.

Design: Prospective cohort study.

The Survival of the Surviving Sepsis Campaign.

Even well-intentioned policies have great potential to cause harm. This statement is vividly illustrated by the influential, yet controversial, Surviving Sepsis Campaign guidelines and subsequent CMS benchmarks. Despite low-quality evidence, tendentious industry ties, and rebuke from the Infectious Disease Society of America (IDSA), these benchmarks continue to eschew therapy driven by clinician expertise and individual patient needs in favor of mandating an arbitrary, one-size-fits-all approach that suspends clinical judgment and promotes indiscriminate use of treatments that have the potential to cause great harm.

Airway Pressure Release Ventilation: A Field Guide for the Emergency Physician.

Airway pressure release ventilation (APRV) is a mode of ventilation that uses high airway pressures to recruit and maintain patients' lung volumes. The goal of this mode of ventilation is 2-fold: first, to maintain patients as close to their functional residual capacity as possible and second, to promote safe spontaneous breathing. APRV should essentially be viewed as continuous positive airway pressure (CPAP), with intermittent releases of that pressure to metabolically support patients who are incapable of managing their ventilatory load.