New this month in Scientific American Emergency Medicine:
- Wide Complex Tachycardia
- Viral Upper Respiratory Infection
Ambulatory monitoring strip of a patient with recurrent presyncope shows repetitive monomorphic ventricular tachycardia.
Gary Green, MD
Sally Graglia, MD
Advanced Cardiac Life Support in Wide-Complex Tachycardia
An unstable patient with wide-complex tachycardia may be approached with the usual advanced cardiac life support algorithms: high-quality chest compressions and defibrillation in pulseless patients and synchronized cardioversion in patients with a pulse. Recent data suggest limited utility of Advanced Cardiac Life Support interventions (medications, advanced airway) compared with basic life support, reminding providers to focus on effective cardiopulmonary resuscitation and defibrillation (avoiding implantable cardioverter-defibrillator or pacemaker devices).
Epiglottitis radiographic thumbprint sign (arrow).
Kristin H. Dwyer, MD MPH
Brigham and Women’s Hospital, Clinical Instructor, Department of Emergency Medicine
James Creswell Simpson, MD
Massachusetts General Hospital, Anesthesia Resident
Epiglottitis in the Adult Patient
Adult epiglottitis has reported mortality between 7 and 20%. A high index of suspicion is recommended in patients who are stridorous, are drooling, or have odynophagia. Airway control is critical; the airway should be secured early and under controlled conditions, with personnel and equipment for surgical airway readily available. Orotracheal intubation or tracheostomy can both trigger a sudden loss of airway, and bag-mask ventilation may worsen airway obstruction. These patients require emergent otolaryngology consultation, and the emergency physician must be prepared to establish a definitive airway. Patients should never be left unmonitored and should be kept sitting up to maximize airway patency.