EM Quick Hits 22 Postpartum Hemorrhage, Phenobarbital in Status Epilepticus, Managed Alcohol Programs, Traumatic Cardiac Arrest, Cholangitis, ED Approach to ARDS
Emergency Medicine Cases - En podcast af Dr. Anton Helman - Tirsdage
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Topics in this EM Quick Hits podcast Anand Swaminathan on ED management of postpartum hemorrhage (00:55) Justin Morgenstern on phenobarbital in pediatric status epilepticus (6:41) Michelle Klaiman on managed alcohol programs (12:16) Andrew Petrosoniak on traumatic cardiac arrest (19:42) Brit Long on diagnosing cholangitis (27:53) Bourke Tillman on ED approach to ARDS Part 1 (33:56) Podcast production, editing and sound design by Anton Helman Podcast written summary & blog post by Anand Swaminathan, Michelle Klaiman, Andrew Petrosoniak & Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. Klaiman, M. Morgenstern J. Long, B. Tillman, B. Petrosoniak, A. EM Quick Hits 22 - Postpartum Hemorrhage, Phenobarbital in Status Epilepticus, Managed Alcohol Programs, Traumatic Cardiac Arrest, Cholangitis, ED Approach to ARDS. Emergency Medicine Cases. September, 2020. https://emergencymedicinecases.com/em-quick-hits-september-2020/. Accessed [date]. ED Approach to Postpartum Hemorrhage * After delivery, don’t forget about mom to focus on the baby. Look for bleeding and initiate aggressive management early. * Postpartum hemorrhage is defined as > 500 cc of bleeding after delivery. If it looks like there’s a lot of blood, start resuscitation. * Start with basic resuscitation - 2 large bore IVs, O2, Cardiac monitor, fluids and blood * Once you recognize postpartum hemorrhage, rally your consultants immediately. * Although there are a number of procedures the EP can perform to slow or stop bleeding, often, these patients will require further intervention * Start by placing a call to obstetrics/gynecology but recognize that some patients will be amenable to interventional radiology (uterine artery embolization). If you don’t have OB/GYN, call your general surgeon. * Uterine atony is the most common cause of postpartum hemorrhage * Start with external uterine massage, progress to internal massage and consider packing. * There are a number of medications that can stop bleeding in atony including oxytocin (1st line), misoprostol and methergine. * Recognize other causes of postpartum hemorrhage if atony is not present * Other causes include retained products of conception, trauma from delivery, uterine inversion, intrinsic bleeding disorders and DIC. Expand to view reference list * Lew GH, Pulia MS: Emergency Childbirth, in Roberts JR, Hedges JR, Custalow CB, et al (eds): Clinical Procedures in Emergency Medicine, ed 6. Philadelphia, Saunders, 2013, Ch 56:p 1155-82. Phenobarbital as 2nd line agent for pediatric status epilepticus * A 2019 single center well done RCT out of South Africa showed that phenobarbital stops twice as many seizures and achieves a non-convulsive state more than twice as fast as phenytoin in children with status epilepticus, suggesting that after benzodiazepines, phenobarbital is the most appropriate second line option in status epilepticus * Our expert suggests that propofol could be used a surrogate to phenobarbital in adults for those of us wh...