ACEP, other lessons learned

It’s over, and having fun in Vegas trumped blogging. So, now that we’re home safe and sound, here’s some other things I learned / reinforced while there:

  • we’re state-of-the-art with our procedural sedation where I work. Good news.
  • for crashing patients, get the sono to the bedside, and think about dissection as a cause early
  • trendelenberg position doesn’t improve BP, and should be abandoned unless trying to start a central line
  • shock for fib, then do CPR without checking for ROSC for 2 minutes (big change)
  • GERD flare-ups and cardiac ischemia are often linked! (Weird but true)
  • soon, the 64 detector CT will do away with diagnostic caths (but not yet)
  • morphine is not helpful for decompensated CHF (dCHF); no appreciable venodilation
  • morphine is, however, a significant risk factor for needing to intubate in dCHF (5x)
  • BiPap and Cpap are equivalent for dCHF, and getting them started early is the key
  • Brugada syndrome is more prevalent than previously thought: look for it in your syncopal patients
  • add colchicine to aspirin for your pericarditis patients
  • things to avoid in pericarditis: indocin and steroids

A fun time was had by all, and it was a good, if sparsely-attended conference with very good speakers.

Now to start incorporating this into my practice…


  1. TraumaDude says:

    Hey Gruntdoc!

    I am an ER RN, traveler, currently on assignment in San Francisco. I am also formerly an HM2. I was a SAR Corpsman with 1st MAW in Iwakuni and then during the first Gulf War I went between the USNS Mercy and Mag 16 in Saudi. So I have a little bit of green running thru my veins.
    I’ve been reading your blog for about 2 weeks now, having found it when a friend sent me the link to the UAB nurses rap video. Hilarious by the way. I read todays blog about the ACEP convention and I hope some of the lessons you listed today get passed on to the other Docs that werent there– especially using BiPap early for CHF’ers. Its a great thing. I’ve seen it work countless times but its still almost as bad as asking for Inapsine!

    Keep up the good work shipmate!

  2. This is a nice blog. Thanks for creating it. You might like ours.

  3. re: shock for fib, then do CPR without checking for ROSC for 2 minutes (big change)

    As a rookie EMT, it looks like I need to get my arms in better shape.

    Do you have info on this? Seems weird to jump up and down on their heart if circulation is back.

  4. The 64-slice CT may do away with the diagnostic cath but it certaintly can’t put a stent in…

    MUSC is doing some seminars with the technology (I think–at least I’ve seen signs around the hospital).

    The prospect of being a cath jockey for a living appeals to me on some days. On others it doesn’t. Hope the radiologists don’t steal my potential livelihood. ;-)

  5. Jeremy –
    Some 64 slice CT cor angios are being interpreted by cardiologists, not radiologists. This is an area of HUGE turf wars.
    I was at ACC in Atlanta last month and went to a lecture re: CT cor angio. A case study was presented where a woman had essentially normal cors; the presenter asked the audience to identify the abnormality seen on the scan – no one guessed right.
    The woman had a breast mass that turned out to be adeno CA.
    After attending that lecture, if I were a cardiologist, I’d
    be very reluctant to take on the liability of interpreting a CT scan.
    And you are right about the CT not being able to do a stent.
    We are cathing a pt this week who had CT done – he has significant calcification, so his lesions may not be amenable to PCI, but he still needs a cath despite the CT.
    Where I think CT will become useful is in the ED where it can be used for pts w/ “atypical” chest pain. Cardiac chest pain, as GruntDoc has pointed out, can frequently be “atypical”.