Electrical Storm can be difficult to manage. Repeated episodes of Ventricular tachycardia, with haemodynamic compromise, that do not respond to defibrillation and potentially to medication, are a significant challenge. We discuss a recent case of just this scenario and it was approached as well as an approach to the Electrical VT Storm Patient.

Is there such an entity as a Hypertensive Urgency? Probably not. Hypertensive Emergencies are a Clinical Diagnosis as they involve end-organ damage.

Apart from Aortic Dissection and preeclampsia, we shouldn't decrease systolic Blood pressure by more than 20-25% in the first hour. What STEMI, or ICH, or stroke?What is the best medication to use? We look at that in this episode, taken from a lecture I gave in 2023.

Here is a controversial paper with mortality findings very different to what has been published before.
The Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial, was a double-blind, randomised, controlled, superiority trial, conducted in 31 French ICUs.
Intravenous hydrocortisone, 200mg, was given within 24 hours of onset of severity criteria (median time < 15 hours). The results were very different to the previous study conducted in 42 ICU centres.

Airway in Cardiac Arrest is still a bit of a mystery. We don't really know if we should intubate early. Contrary to prior studies showing no benefit of intubation over BVM or SGA, new evidence may be pointing in a different direction. We don't know the correct rate of breaths or volume of breaths or FiO2. Small animal studies and 'expert' opinion restrict our delivery of breaths to a maximum of 10 per minute and the volume of each breath to about 500 mL. 

This has resulted in some centres now using paediatric BVMs for adult resuscitation. Do these work? Previous studies may have shown no inferiority, but here is a new study, that suggests that traditional BVMs may be better.

How do you approach the patient in shock? Septic shock, Cardiogenic Shock, shock due to a massive pulmonary embolism?

There is no perfect drug, however Noradrenaline may be as perfect as it gets.

The patient in asystole during cardiac arrest, has a very poor prognosis. But is it really asystole? Is there benefit in giving one shock to the patient? Surely we need to look at all the leads and increase the amplitude, to see of this is low amplitude VF. Even if we find low amplitude VF, will we be able to successfully defibrillate them? Aren't we supposed to perform CPR to increase the amplitude of the VF waveform?....we've been doing this, with no success. Delivering one shock may be very appropriate.

SCAD is a separation of layers of the coronary artery wall, resulting in  intramural haemorrhage and haematoma formation.  Coronary insufficiency results due to the narrowing of the coronary artery lumen, from an expanding intramural hameatoma. SCAD may or may not involve an intimal layer tear.
SCAD plays a prominent role in myocardial infarction in women. In total the disease accounts for approximately 1% of all acute myocardial infarctions. However 90% of cases of SCAD occurs in female patients between the ages of 47  and 53. It accounts for up to 20% of myocardial infarctions during pregnancy and is now increasingly being reported in older women.

Although the condition does occur in males, its prevalence is very low.

The Clinical Cases Podcast, also called The EM Show. Coming to EM Mastery Soon