I just posted on the journal articles page a fun article by Rapezzi et al about how modern tools is killing of the art of medicine and the role of the physician as a diagnostician. I first read about this article when it was referenced on emcrit.org. Food for thought…..
Click on the link below to read:
Medicine Detectives Article
A scenario we had the other day, and one that I’m sure would make most ED docs very nervous. 7 day old, cardiac arrest. No airway, no access.
Airway established, no peripheral IV available. IO attempts (x3) failed.
Femoral line attempts (x2) failed.
Umbilical line attempt – unable to thread past abdominal wall…it had closed off.
The patient had complete collapse of all vasculature.
1. Don’t forget about Epi down the ET tube. Probably won’t do much. But you may feel better/feel like you’re doing something for the patient.
2. Remember the old school venous cutdown. In a patient like this it would be pretty much the last type of access available. The most common options would be the saphenous by the ankle or the basilic vein in the arm.
Have a look at this video to review the technique. Definitely a last ditch effort, but a good one to not forget about, as it may come in handy some day.
Additionally, if you have a case such as the one mentioned above (<2wks neonate with cardiovascular collapse) don’t forget that it could be due to the PDA closing, and they have a ductal dependent cardiac lesion.
Don’t forget to start prostaglandins….
I am a general emergency medicine and pediatric emergency medicine physician at an academic institution. The goal of this website and blog will be to try and compile as much useful information about pediatric EM and the acute resuscitation of the pediatric patient as possible into one source. I’ll be doing the searching for great videos, articles, posts by other people and compiling them into one area so that you don’t have to. It will be a continual work in progress, so bear with me while we get this off the ground. Also, if you have ideas, opinions, interesting cases, articles or videos that you’d like to send along this would obviously be greatly appreciated. I’d be more than happy to post on your behalf and of course reference who sent me the info.
So, lets try to have fun while learning how to provide the best pediatric emergency care possible. Thanks for reading.
matt murray md