Emergency Medicine Cases EM Quick Hits 61 TEE in Cardiac Arrest, Nebulized Ketamine, Cellulitis Update, SQ Insulin for DKA, Medicolegal DDx Documentation Tips
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Dec 3, 2024 
Join Ross Prager, an intensivist from London with expertise in point-of-care ultrasound, as he discusses the transformative role of transesophageal echocardiography (TEE) during cardiac arrest. Justin Morgenstern shares the latest research on nebulized ketamine as a game-changing analgesic in the ED, especially for older patients. Matthew McArthur presents compelling evidence for using subcutaneous insulin protocols for managing DKA. Together, they highlight new insights that enhance patient care and emergency protocols.
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TEE Insertion
- Intubate the patient before performing TEE, which simplifies probe insertion.
- A laryngoscope can facilitate visualization, if readily available.
The Low End-Tidal CO2 Case
- A young patient in witnessed VF arrest had low end-tidal CO2 despite seemingly good CPR.
- TEE revealed compressions over the LVOT; repositioning improved CO2 and led to ROSC.
Nebulized Ketamine vs. Morphine
- Nebulized ketamine provides short-term pain relief comparable to IV morphine.
- Consider it when IV access is difficult, but oral morphine offers better long-term pain management.