“Who in their right mind would take an inch and a half needle, fill it
with some bupivacaine, and stab somebody in the back of the neck to get
rid of their headache?”
An ALTE, or apparent life-threatening event, is defined somewhat
nebulously. Essentially, it is a frightening episode involving a
combination of apnea, change in color or tone, choking or gagging. The
differential diagnosis for an ALTE is broad, ranging from relatively
benign conditions such as gastro-esophageal reflux to congenital heart
disease or child abuse.
In October’s EMRAP, Dr. Sanjay Arora discussed procedural sedation and
analgesia (PSA) with Mel Herbert. Their discussion centered on ketofol,
the combination of ketamine and propofol, which has been proposed as an
ideal agent for PSA. The question of the hour: Could Ketofol be the
You walk into your next code and it’s a man in his 60s who collapsed on
his way to his cardiologist’s office. His wife insists that he doesn’t
need CPR because he has a kind of artificial heart, an LVAD. No one in
the department has ever seen a patient with one of these before.
We just finished a two-part series with one of our former Chief
Residents, Dr. Zachary Shinar. Zach has been working in San Diego at
Sharp Memorial Hospital and more recently at UC San Diego. What he has
been up to down there is nothing short of incredible.