For anyone that has never heard Eagles member Corey Slovis, MD, FACP, FACEP, -- you’re missing out! New to the JEMS staff, I didn’t quite know what to expect of EMS Today. Thus far, the conference has exceeded my expectations. Slovis is an infamous presenter known for breaking down critical information into five points. Whether he’s addressing causes or treatments for a medical condition, Slovis always finds a way to stay true to his rule of five. That is, unless you’re asking about the four determinants of cardiac output, but Slovis joked that science isn’t always perfect.
In his talk, “Selected Medical Emergencies”, Slovis outlined five causes and five treatments for patients with altered mental status (AMS), diabetic ketoacidosis (DKA), hyperkalemia, wheezing, CHF and more. Here are some of the causes that were shared.
Five Causes of AMS:
- Vital-sign abnormalities;
- Infectious; and
Slovis pointed out that you should always look for vital-sign abnormalities first, toxic-metabolic second, and psychiatric as a last resort (causes three and four are interchangeable in order). He cautioned that although it may be tempting to look at a patient that’s belligerent or delirious and “diagnose” the patient as crazy -- don’t make that mistake.
Five Causes of DKA:
- Indiscretion; and
- Insulin lack.
Among the five treatments, the take away message is to treat aggressively with volume. The average patient with DKA could be down as much as 3.5 L of fluid.
Five Causes of Hyperkalemia:
- Cell death; and
One of the most interesting points made during the
presentation was in regard to the five recommended treatments for CHF:
- Nitroglycerin (NTG);
- Administer Lasix; and
- BiPAP or CPAP.
Out of these five treatments, Slovis argued that you could actually skip Lasix and rely on NTG and CPAP. Although the use of Lasix might be a popular solution in your system, there’s one fundamental problem. The drug can take between 20 and 40 minutes to work. In a study of 144 patients treated with Lasix, 42% didn’t have CHF. Instead of using Lasix, Slovis recommends waiting for the NTG to work and moving on to BiPAP or CPAP. In another study regarding the use of CPAP, 15 trials with more than 700 patients had a decrease in mortality rate by 47%. In this same study, the need for intubation decreased by 60%. According to Slovis, you’re providing exemplary care with your ABCs, NTG and either CPAP or BiPAP. Of course, these are just new data points that he asks the audience to consider, and he admitted his service still carries the drug.
Above all, Slovis says you should always remember three rules (although it’s not five, I’m sure he would provide two more if prompted) to
live by in the field:
- Assume the worst;
- Err in a way that the patient suffers the least; and
- Share your mistakes.