EM Quick Hits 47 HFNC, Dissection Drugs, ADJUST-UNLIKELY for PE, Antibiotic Course Duration, Skin Glue Hacks, ESP Block, Learner Oversight

Topics in this EM Quick Hits podcast Anand Swaminathan on 3-pronged approach to aortic dissection management (2:03) Jonathan Wallace on rural practice tips for glue removal and ESP block for renal colic (9:06) Sara Gray on everything you need to know about High Flow Nasal Cannula (15:21) Maria Ivankovic on reducing the duration of antibiotic therapy (34:10) Tahara Bhate on handover and learner oversight on QI corner (39:21) Kerstin De Wit on the ADJUST-UNLIKELY tool for pulmonary embolism (49:13) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Anand Swaminathan, Sara Gray, Maria Ivankovic, Alex Chan edited by Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. Wallace, J. Gray, S. Ivankovic, M. Bhate, T. De Wit, K. EM Quick Hits 47 – HFNC, Dissection Drugs, Septic Arthritis, PE Testing, Antibiotic Course Length, Skin Glue Hacks, ESP Block. Emergency Medicine Cases. March, 2023 https://emergencymedicinecases.com/em-quick-hits-march-2023/. Accessed September 17, 2024. Aortic Dissection 3-pronged approach to heart rate and blood pressure control Aortic dissection is a hypertensive emergencies. Rapid control of both blood pressure and heart rate are essential to minimize extension of acute aortic dissection. * Adequate analgesia: should be achieved before the diagnosis of aortic dissection is confirmed and before attempts at HR and BP control, to mitigate the contribution of catecholaminergic drive from pain to HR and BP * Fentanyl 1mcg/kg  q15-20 minutes * Heart rate control: target HR 50-60BPM * Esmolol (500-1000mcg/kilo) bolus followed by an infusion (50mcg/kg/min with reassessments every 5-10 minutes) * Labetalol may be used as an alternative, which improves both HR and BP * Blood pressure control: target SBP 90-100mmHg * Nicardipine or Clovidipine are preferred agents if available * Diltiazem 0.25-0.35mg/kg over 2 minutes, followed by a 5-10mg/hr infusion to target BP is acceptable as an alternative * Nitroprusside may additionally be used though reflex tachycardia may be an issue Episode 92 – Aortic Dissection Live from The EM Cases Course ECG Cases 34 – ECG Interpretation in Aortic Dissection Expand to view reference list * Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Journal of the American College of Cardiology. 2010;55(14):e27-e129. doi:10.1016/j.jacc.2010.02.015 * Nienaber CA, Clough RE. Management of acute aortic dissection. The Lancet. 2015;385(9970):800-811. doi:10.1016/S0140-6736(14)61005-9 * Evangelista A, Isselbacher EM, Bossone E, et al. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation. 2018;137(17):1846-1860. doi:10.1161/CIRCULATIONAHA.117.031264 * Shimizu H, Fukui T, Tabata M, et al.