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EM@3AM: Murine Typhus

EMDocs

2017 Feb;166:16-24. Tsioutis C, Zafeiri M, Avramopoulos A, Prousali E, Miligkos M, Karageorgos SA. Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review. doi: 10.1016/j.actatropica.2016.10.018. 2016.10.018. Tello-Martin R, Dzul-Rosado K, Zavala-Castro J, Lugo-Caballero C.

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REBEL Core Cast 108.0 – Angioedema

RebelEM

Take Home Points: Airway management is paramount; expect a challenging intubation and consider controlling the airway early if there is apparent airway compromise. Understanding the cause of angioedema (mast cell vs. bradykinin mediated) helps dictate directed management. PMID 20954277 Sinnert R et al.

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Bougie: First Pass or Rescue Device?

ACEP Now

These limitations are sufficient to question the recommendation to use a bougie as first line airway management. For patients requiring emergency airway management, the use of a bougie is an important technique. Having a bougie readily available with the usual airway equipment may expedite airway management.

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Intubation

PHEM Cast

AAGBI Safer Prehospital Anaesthesia 2017, available here. Positioning From: [link] Recommended Rich Levitan resources Podcast 70 – Airway Management with Rich Levitan Airway axes From: McGuire B, Hodge K. Crit Care 21, 31 (2017). Tracheal intubation. Anaesthesia & Intensive Care Medicine. 20(12);681-686.

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Proning for ARDS

Northwestern EM Blog

Relative contraindications are several, including difficulty with airway management, facial trauma, ventricular assist device, intra-aortic balloon pump, severe chest wall lesions or rib fractures, massive hemoptysis, unstable pelvic or long bone fractures, and open abdominal wounds. 2017 Jan;151(1):215-224. Intensive Care Med.

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Myasthenic Crisis

EM Guide Wire

Can also try awake intubation with propofol, fentanyl or ketamine Avoid pyridostigmine during a crisis as it increases secretions and make airway management difficult! Myasthenia Gravis and Crisis: Evaluation and Management in the Emergency Department. Start at one-third to one-half the standard dose. & Levine, J.M

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Don’t Become Obsolete: The EM Physician’s Fight Against Procedural Decay

RebelEM

A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance. Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay. BMJ Qual Saf. PMID: 28866621. J Am Osteopath Assoc.

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